Provider Demographics
NPI:1992447163
Name:1619 INVESTMENTS DBA MILLS OPTOMETRY, LLC
Entity type:Organization
Organization Name:1619 INVESTMENTS DBA MILLS OPTOMETRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:VANDEN HULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-963-0245
Mailing Address - Street 1:11619 TOMAHAWK CREEK PKWY APT B
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-2640
Mailing Address - Country:US
Mailing Address - Phone:816-797-4700
Mailing Address - Fax:
Practice Address - Street 1:9350 MARSHALL DR
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3845
Practice Address - Country:US
Practice Address - Phone:913-227-3706
Practice Address - Fax:913-227-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty