Kevin D Atwood, O.D.
Individual provider Active NPI Optometrist · Lees Summit, MO
NPI 1366569709 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1366569709
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- TO3103 (MO)
- Practice address
- 1000 NE Sam Walton LN
Lees Summit, MO 64086-8426 - Phone
- (816) 246-8085
- NPI assigned
- Mar 22, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TO3103 | MO | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TO3103 | MO | Yes |
Addresses
Primary practice location
1000 NE Sam Walton LN
Lees Summit, MO 64086-8426
Mailing address
409 NE Parks Edge Dr
Lees Summit, MO 64064-1270
Phone (816) 308-9500
Other providers in Lees Summit, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.