Provider Demographics
NPI:1417495797
Name:EYE ASSOCIATES OF SOUTH OVERLAND PARK
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF SOUTH OVERLAND PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIEFKES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-339-9090
Mailing Address - Street 1:10120 W 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1600
Mailing Address - Country:US
Mailing Address - Phone:913-339-9090
Mailing Address - Fax:913-339-6417
Practice Address - Street 1:8029 W 159TH ST.
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223
Practice Address - Country:US
Practice Address - Phone:913-339-9090
Practice Address - Fax:913-339-6417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty