Provider Demographics
NPI:1154672533
Name:SMITHVILLE EYE CENTER LLC
Entity Type:Organization
Organization Name:SMITHVILLE EYE CENTER LLC
Other - Org Name:WYANDOTTE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMEBER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-873-0202
Mailing Address - Street 1:21 N 12TH ST
Mailing Address - Street 2:101
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-5161
Mailing Address - Country:US
Mailing Address - Phone:816-873-0202
Mailing Address - Fax:816-873-0203
Practice Address - Street 1:21 N 12TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-5161
Practice Address - Country:US
Practice Address - Phone:816-873-0202
Practice Address - Fax:816-873-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1601261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center