Organization Active NPI

Professional Eyecare Oak Park Inc.

  • Optometrist
  • Overland Park, KS
National Provider Identifier
1952452229
Registry record updated Aug 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1308 Issued in KS
Legal business name
PROFESSIONAL EYECARE OAK PARK INC.
Practice address
11121 W 95TH St
Overland Park, KS 66214-1824
Phone
(913) 492-7728
Fax
(913) 492-5217
NPI assigned
Jan 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2010

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

Authorized official

Name
Denise Lorraine Royer
Title
Managed Care Manager
Phone
(913) 696-0092

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1308 KS Primary

Addresses

Primary practice location

11121 W 95TH St
Overland Park, KS 66214-1824

Mailing address

11121 W 95TH St
Overland Park, KS 66214-1824
Phone (913) 492-7728

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051108000439 KS Part B Supplier - Clinic/Group Practice 8921990433 Receives reassigned benefits from 6 practitioners
Practice locations: Overland Park, KS

National Provider Directory

National Provider Directory

Locations

11433 W 87th Ter
Overland Park, KS 66214

11205 W 95th St
Overland Park, KS 66214
Phone (913) 492-7728

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": "1168819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282521600000",
    "number": "1952452229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11121 W 95TH ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662141824",
            "telephone_number": "913-492-7728",
            "fax_number": "913-492-5217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11121 W 95TH ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662141824",
            "telephone_number": "913-492-7728",
            "fax_number": "913-492-5217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL EYECARE OAK PARK INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-15",
        "last_updated": "2010-08-23",
        "status": "A",
        "authorized_official_last_name": "ROYER",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "LORRAINE",
        "authorized_official_title_or_position": "MANAGED CARE MANAGER",
        "authorized_official_telephone_number": "913-696-0092"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "KS",
            "license": "1308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2010; 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.