Provider Demographics
NPI:1588873814
Name:LAFERLA FAMILY EYECARE OD PC
Entity type:Organization
Organization Name:LAFERLA FAMILY EYECARE OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:LAFERLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-741-6737
Mailing Address - Street 1:8301 N CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64152-2041
Mailing Address - Country:US
Mailing Address - Phone:816-741-6737
Mailing Address - Fax:816-746-5850
Practice Address - Street 1:8301 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64152-2041
Practice Address - Country:US
Practice Address - Phone:816-741-6737
Practice Address - Fax:816-746-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2830152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U52757Medicare UPIN
Q344536Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
Q340000Medicare ID - Type UnspecifiedGROUP NUMBER
U05601Medicare UPIN