Provider Demographics
NPI:1033240619
Name:FRANKEN EYE CLINIC INC
Entity Type:Organization
Organization Name:FRANKEN EYE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:FRANKEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-985-2687
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:116 EAST WALNUT STREET
Mailing Address - City:TROY
Mailing Address - State:KS
Mailing Address - Zip Code:66087-0188
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:116 EAST WALNUT STREET
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:KS
Practice Address - Zip Code:66087-0188
Practice Address - Country:US
Practice Address - Phone:785-985-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1618152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100421710AMedicaid
KSU90859Medicare UPIN
KS650875Medicare ID - Type Unspecified
KS100421710AMedicaid