Provider Demographics
NPI:1215120209
Name:LEAWOOD FAMILY EYE CARE PA
Entity type:Organization
Organization Name:LEAWOOD FAMILY EYE CARE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-345-8020
Mailing Address - Street 1:11225 NALL AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211
Mailing Address - Country:US
Mailing Address - Phone:913-345-8020
Mailing Address - Fax:913-338-5483
Practice Address - Street 1:11225 NALL AVE
Practice Address - Street 2:STE 100
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211
Practice Address - Country:US
Practice Address - Phone:913-345-8020
Practice Address - Fax:913-338-5483
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEAWOOD FAMILY EYE CARE PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty