Provider Demographics
NPI:1477586915
Name:POWELL VISION CARE
Entity Type:Organization
Organization Name:POWELL VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER LLC/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-338-1749
Mailing Address - Street 1:10122 THEDEN CIR
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66220-2695
Mailing Address - Country:US
Mailing Address - Phone:913-338-1749
Mailing Address - Fax:913-338-2918
Practice Address - Street 1:11701 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2201
Practice Address - Country:US
Practice Address - Phone:913-338-1749
Practice Address - Fax:913-338-2918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
33797018OtherBCBS OF KC
33797018OtherBCBS OF KC