Provider Demographics
NPI:1275008344
Name:PAUL BRINCKMAN, OD, LLC.
Entity Type:Organization
Organization Name:PAUL BRINCKMAN, OD, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-707-5126
Mailing Address - Street 1:PO BOX 3047
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66063-1047
Mailing Address - Country:US
Mailing Address - Phone:913-707-5126
Mailing Address - Fax:888-538-6503
Practice Address - Street 1:301 E COOPER AVE
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1260
Practice Address - Country:US
Practice Address - Phone:660-747-7117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT03428OtherMISSOURI LISCENSE