Provider Demographics
NPI:1366599672
Name:PHYSICIANS OPTICAL, INC
Entity type:Organization
Organization Name:PHYSICIANS OPTICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-829-4441
Mailing Address - Street 1:21020 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7200
Mailing Address - Country:US
Mailing Address - Phone:913-829-4441
Mailing Address - Fax:913-829-5571
Practice Address - Street 1:21020 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7200
Practice Address - Country:US
Practice Address - Phone:913-829-4441
Practice Address - Fax:913-829-5571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS318562332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0841940001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER