Provider Demographics
NPI:1033009915
Name:FAMILY EYECARE CENTER OF DESOTO
Entity type:Organization
Organization Name:FAMILY EYECARE CENTER OF DESOTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-682-2929
Mailing Address - Street 1:2301 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-4214
Mailing Address - Country:US
Mailing Address - Phone:913-682-2929
Mailing Address - Fax:913-682-2999
Practice Address - Street 1:8781 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:KS
Practice Address - Zip Code:66018-9106
Practice Address - Country:US
Practice Address - Phone:913-290-5085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-03
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty