Provider Demographics
NPI:1184834491
Name:NITSCHKE EYE CARE, PA
Entity Type:Organization
Organization Name:NITSCHKE EYE CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NITSCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-422-7781
Mailing Address - Street 1:13025 KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:BONNER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66012-9206
Mailing Address - Country:US
Mailing Address - Phone:913-422-7781
Mailing Address - Fax:913-422-7796
Practice Address - Street 1:13025 KANSAS AVE
Practice Address - Street 2:
Practice Address - City:BONNER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66012-9206
Practice Address - Country:US
Practice Address - Phone:913-422-7781
Practice Address - Fax:913-422-7796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1407152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS27968014OtherBLUE CROSS BLUE SHIELD GP
KS003152Medicaid
KS20417050OtherBCBS OF KANSAS CITY IND.
KS0006205CMedicare ID - Type UnspecifiedMEDICARE DESOTO
KS20417050OtherBCBS OF KANSAS CITY IND.
KS4025870002Medicare ID - Type UnspecifiedDME REGION D