Provider Demographics
NPI:1306003710
Name:BRINCKMAN AND ASSOCIATES CHTD
Entity Type:Organization
Organization Name:BRINCKMAN AND ASSOCIATES CHTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRINCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-764-3937
Mailing Address - Street 1:PO BOX 3047
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66063
Mailing Address - Country:US
Mailing Address - Phone:913-764-3937
Mailing Address - Fax:913-764-3947
Practice Address - Street 1:16124 W 135TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1517
Practice Address - Country:US
Practice Address - Phone:913-764-3937
Practice Address - Fax:913-764-3947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS1543152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200335030AMedicaid
KS200335030AMedicaid
M900000Medicare PIN