Provider Demographics
NPI:1285095125
Name:WESTPORT EYECARE LLC
Entity type:Organization
Organization Name:WESTPORT EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-753-2020
Mailing Address - Street 1:4233 ROANOKE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-4816
Mailing Address - Country:US
Mailing Address - Phone:816-753-2020
Mailing Address - Fax:816-753-2697
Practice Address - Street 1:4233 ROANOKE RD STE 201
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-4816
Practice Address - Country:US
Practice Address - Phone:816-753-2020
Practice Address - Fax:816-753-2697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-18
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005017513152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty