Provider Demographics
NPI:1417556382
Name:KANNARR EYE CARE LLC
Entity Type:Organization
Organization Name:KANNARR EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KANNARR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:620-235-1737
Mailing Address - Street 1:4 S NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-1309
Mailing Address - Country:US
Mailing Address - Phone:620-223-0850
Mailing Address - Fax:620-223-2464
Practice Address - Street 1:4 S NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-1309
Practice Address - Country:US
Practice Address - Phone:620-223-0850
Practice Address - Fax:620-223-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty