Provider Demographics
NPI:1073557112
Name:PHILBROOK, JANE WINKLER (OD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:WINKLER
Last Name:PHILBROOK
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:7161 STATE AVE
Mailing Address - Street 2:PO BOX 12174
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-3001
Mailing Address - Country:US
Mailing Address - Phone:913-299-3548
Mailing Address - Fax:913-299-9830
Practice Address - Street 1:5150 ROE BLVD
Practice Address - Street 2:
Practice Address - City:ROELAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66205-2359
Practice Address - Country:US
Practice Address - Phone:913-403-9013
Practice Address - Fax:913-273-5444
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS1338152WP0200X, 152WV0400X, 152WX0102X, 152W00000X
MOT03004152W00000X, 152WP0200X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS19207014OtherBLUE CROSS BLUE SHEILD
KS100219020DMedicaid
KSB432258AMedicare PIN
KS16468Medicare UPIN