Provider Demographics
NPI:1316009129
Name:EYE ASSOCIATES OF OVERLAND PARK PA
Entity type:Organization
Organization Name:EYE ASSOCIATES OF OVERLAND PARK PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:PENNIPEDE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-339-9090
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO13235027OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY
KS447929OtherBLUE CROSS BLUE SHIELD OF KANSAS
KSDB3942OtherRR MEDICARE
KS4174510001Medicare NSC
MO13235027OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY