Provider Demographics
NPI:1285793786
Name:SIEFKES, MARK L (OD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:SIEFKES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 W 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213
Mailing Address - Country:US
Mailing Address - Phone:913-339-9090
Mailing Address - Fax:913-339-6417
Practice Address - Street 1:10120 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213
Practice Address - Country:US
Practice Address - Phone:913-339-9090
Practice Address - Fax:913-339-6417
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1539152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO25757045OtherBCBSKC FOR EYE ASSOCIATES OF LEAWOOD
KSR178660OtherMEDICARE PART B FOR EYE ASSOCIATES OF SHAWNEE
MO25757035OtherBCBSKC FOR EYE ASSOCIATES OF SHAWNEE
KS410043137OtherRR MEDICARE FOR EYE ASSOCIATES OF OVERLAND PARK
MO25757015OtherBCBSKC FOR EYE ASSOCIATES OF OVERLAND PARK
MO25757025OtherBCBSKC FOR EYE ASSOCIATES OF OLATHE
KS5109645OtherAETNA
KSR198660OtherMEDICARE PART B FOR EYE ASSOCIATES OF OVERLAND PARK
KA1109006OtherMEDICARE PART B FOR EYE ASSOCIATES OF LEAWOOD
KSR188660OtherMEDICARE PART B FOR EYE ASSOCIATES OF OLATHE
KS5109645OtherAETNA
MO25757035OtherBCBSKC FOR EYE ASSOCIATES OF SHAWNEE
U73047Medicare UPIN
KS410043137OtherRR MEDICARE FOR EYE ASSOCIATES OF OVERLAND PARK