Provider Demographics
NPI:1114945003
Name:SILVERSTEIN EYE CENTERS OPTICAL
Entity Type:Organization
Organization Name:SILVERSTEIN EYE CENTERS OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:AYN
Authorized Official - Last Name:ENDICOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-595-3908
Mailing Address - Street 1:4240 BLUE RIDGE BLVD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-1713
Mailing Address - Country:US
Mailing Address - Phone:816-358-3600
Mailing Address - Fax:816-358-9903
Practice Address - Street 1:4240 BLUE RIDGE BLVD
Practice Address - Street 2:SUITE 1000
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-1713
Practice Address - Country:US
Practice Address - Phone:816-358-3600
Practice Address - Fax:816-358-9903
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SILVERSTEIN EYE CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-18
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4936510001Medicare NSC