Organization Active NPI

Lawrence Family Vision Clinic P a

  • Optometrist
  • Lawrence, KS
National Provider Identifier
1396895009
Registry record updated Jan 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
LAWRENCE FAMILY VISION CLINIC P A
Practice address
3111 W 6TH St
Lawrence, KS 66049-3101
Phone
(785) 749-2020
NPI assigned
Jan 12, 2007
Last updated
Jan 15, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Mily Boone-Salazar
Title
Office Manager
Phone
(785) 749-2020

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

3111 W 6TH St
Lawrence, KS 66049-3101

Mailing address

3111 W 6TH St
Lawrence, KS 66049-3101
Phone (785) 749-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050328000775 KS Part B Supplier - Clinic/Group Practice 4587610043 Receives reassigned benefits from 4 practitioners
Practice locations: Lawrence, KS

National Provider Directory

National Provider Directory

Locations

3111 W 6th St
Lawrence, KS 66049
Phone (785) 749-2020

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358208000000",
    "number": "1396895009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3111 W 6TH ST",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660493101",
            "telephone_number": "785-749-2020",
            "fax_number": "785-749-2323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3111 W 6TH ST",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660493101",
            "telephone_number": "785-749-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWRENCE FAMILY VISION CLINIC P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2013-01-15",
        "status": "A",
        "authorized_official_last_name": "BOONE-SALAZAR",
        "authorized_official_first_name": "MILY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "785-749-2020",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrence, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.