Provider Demographics
NPI:1194906461
Name:FAIRWAY EYE CENTER, INC
Entity type:Organization
Organization Name:FAIRWAY EYE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMERTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-362-2323
Mailing Address - Street 1:3414 SHAWNEE MISSION PKWY
Mailing Address - Street 2:
Mailing Address - City:FAIRWAY
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2663
Mailing Address - Country:US
Mailing Address - Phone:913-362-2323
Mailing Address - Fax:913-362-2333
Practice Address - Street 1:3414 SHAWNEE MISSION PKWY
Practice Address - Street 2:
Practice Address - City:FAIRWAY
Practice Address - State:KS
Practice Address - Zip Code:66205-2663
Practice Address - Country:US
Practice Address - Phone:913-362-2323
Practice Address - Fax:913-362-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1672152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSR070000AMedicare PIN
MOR070000Medicare PIN