Susan Kristine Bullano, O.D.
Individual provider Active NPI Optometrist · Mission, KS
NPI 1891706412 · NPPES record last updated Feb 26, 2013
Key facts
- NPI
- 1891706412
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1858 (KS)
- Practice address
- 6120 Johnson Dr
Mission, KS 66202-3333 - Phone
- (913) 262-3937
- Fax
- (913) 262-3942
- NPI assigned
- Aug 10, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Pennsylvania College of Optometry, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northland Eye Specialists PC
Practice addresses (Care Compare)
1200 Landmark Ave
Liberty, MO 64068-1051
Phone (816) 792-1900
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061213000565 | MO | Practitioner - Optometry | 0749289080 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1858 | KS | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pingel Family Eyecare, LLC | Optometrist | Past |
Accepting new patients |
| Honson & Honson, Inc. | Optometrist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1858 | KS | Yes |
Addresses
Primary practice location
6120 Johnson Dr
Mission, KS 66202-3333
Mailing address
13385 Sycamore Dr
Platte City, MO 64079-8358
Phone (816) 390-8644
Other providers in Mission, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.