Provider Demographics
NPI:1457486375
Name:BURLINGAME & MOCK VISION ASSOCIATES, INC
Entity Type:Organization
Organization Name:BURLINGAME & MOCK VISION ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BUFFIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-451-0001
Mailing Address - Street 1:11500 W. 119TH STREET
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11500 W. 119TH STREET
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2002
Practice Address - Country:US
Practice Address - Phone:913-451-0001
Practice Address - Fax:913-451-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1275152W00000X
KS1577152W00000X
KS1259-2152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1259-2OtherLIC. #
KS1275OtherLIC. #
KS1577OtherLIC. #
KS1275OtherLIC. #
KSU08553Medicare UPIN
KS1577OtherLIC. #
KS1259-2OtherLIC. #
KSU77193Medicare UPIN