Provider Demographics
NPI:1992776793
Name:MOCK, BUFFIE JANE (OD)
Entity type:Individual
Prefix:DR
First Name:BUFFIE
Middle Name:JANE
Last Name:MOCK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5195 W 199TH ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:KS
Mailing Address - Zip Code:66085-9016
Mailing Address - Country:US
Mailing Address - Phone:913-239-8884
Mailing Address - Fax:
Practice Address - Street 1:11500 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2002
Practice Address - Country:US
Practice Address - Phone:913-451-0001
Practice Address - Fax:913-451-1659
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
27308012OtherBLUE CROSS BLUE SHIELD
KS1992776793Medicare NSC
27308012OtherBLUE CROSS BLUE SHIELD
KSD39A819Medicare PIN