Provider Demographics
NPI:1316365562
Name:SANDRA L EASTER
Entity Type:Organization
Organization Name:SANDRA L EASTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:EASTER
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:620-331-9090
Mailing Address - Street 1:115 W LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-3311
Mailing Address - Country:US
Mailing Address - Phone:620-331-9090
Mailing Address - Fax:620-331-0011
Practice Address - Street 1:115 W LAUREL ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3311
Practice Address - Country:US
Practice Address - Phone:620-331-9090
Practice Address - Fax:620-331-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1547152W00000X
KS1958152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1871686055OtherBLUE CROSS BLUE SHIELD
KS1912346552Medicaid
KS1871686055Medicare NSC
KS1871686055Medicare Oscar/Certification
KS1912346552Medicare NSC