Provider Demographics
NPI:1073837464
Name:EYECARE ASSOCIATES OF OSAWATOMIE, P.A.
Entity Type:Organization
Organization Name:EYECARE ASSOCIATES OF OSAWATOMIE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIS/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-256-2176
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:OSAWATOMIE
Mailing Address - State:KS
Mailing Address - Zip Code:66064-0456
Mailing Address - Country:US
Mailing Address - Phone:913-256-2176
Mailing Address - Fax:913-755-2787
Practice Address - Street 1:524 BROWN AVE
Practice Address - Street 2:
Practice Address - City:OSAWATOMIE
Practice Address - State:KS
Practice Address - Zip Code:66064-1322
Practice Address - Country:US
Practice Address - Phone:913-256-2176
Practice Address - Fax:913-755-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1713152W00000X
KS12532152W00000X
KS11942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS410020656OtherRAILROAD MEDICARE
KSKA1721OtherMEDICARE ID-TYPE UNSPECIFIED
KS100218260AMedicaid
KSP00355811OtherRAILROAD MEDICARE
KS200357920AMedicaid
KS410014216OtherRAILROAD MEDICARE
KSCA0104OtherRAILROAD MEDICARE
KS650544OtherMEDICARE ID-TYPE UNSPECIFIED
KSDQ3063OtherRAILROAD MEDICARE
KS100218090AMedicaid
KSKA1721OtherMEDICARE ID-TYPE UNSPECIFIED
KS100218090AMedicaid