Provider Demographics
NPI:1215334925
Name:KRIS REIMER OD, LLC
Entity type:Organization
Organization Name:KRIS REIMER OD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:REIMER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:620-275-2222
Mailing Address - Street 1:410 N CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-6134
Mailing Address - Country:US
Mailing Address - Phone:620-275-2222
Mailing Address - Fax:620-275-0829
Practice Address - Street 1:410 N CAMPUS DR
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-6134
Practice Address - Country:US
Practice Address - Phone:620-275-2222
Practice Address - Fax:620-275-0829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1493152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201272620AMedicaid