Provider Demographics
NPI:1427041797
Name:EUDALY, LON S (OD)
Entity Type:Individual
Prefix:DR
First Name:LON
Middle Name:S
Last Name:EUDALY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 S CLIFF AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7015
Mailing Address - Country:US
Mailing Address - Phone:816-478-1230
Mailing Address - Fax:816-350-4585
Practice Address - Street 1:11500 GRANADA ST
Practice Address - Street 2:DISCOVER VISION CENTERS
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1453
Practice Address - Country:US
Practice Address - Phone:816-478-1230
Practice Address - Fax:816-350-6980
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02523152W00000X
KS11823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410030654OtherRAILROAD MEDICARE
KSP00685108OtherRAILROAD MEDICARE
U08549Medicare UPIN
MO406A00014Medicare PIN
MO406000007Medicare PIN
410030654OtherRAILROAD MEDICARE