Provider Demographics
NPI:1003196882
Name:MOSIER ESLIT, ANNIE MARIE (OD)
Entity Type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:MARIE
Last Name:MOSIER ESLIT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:ANNIE
Other - Middle Name:MARIE
Other - Last Name:MOSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:650 HUEBNER RD
Mailing Address - Street 2:
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-4030
Mailing Address - Country:US
Mailing Address - Phone:785-239-7000
Mailing Address - Fax:785-240-8341
Practice Address - Street 1:650 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-4030
Practice Address - Country:US
Practice Address - Phone:785-240-7335
Practice Address - Fax:785-240-8341
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1986152W00000X, 152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA3592001Medicare UPIN