Provider Demographics
NPI:1245382829
Name:PROFESSIONAL EYECARE - BANNISTER
Entity Type:Organization
Organization Name:PROFESSIONAL EYECARE - BANNISTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:ROYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-696-0092
Mailing Address - Street 1:5600 E BANNISTER RD RM 188
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64192-1000
Mailing Address - Country:US
Mailing Address - Phone:816-765-3310
Mailing Address - Fax:816-765-3181
Practice Address - Street 1:5600 E BANNISTER RD RM 188
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64192-1000
Practice Address - Country:US
Practice Address - Phone:816-765-3310
Practice Address - Fax:816-765-3181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2880152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty