Provider Demographics
NPI:1497362628
Name:FT SCOTT EYE CENTER P.A.
Entity Type:Organization
Organization Name:FT SCOTT EYE CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RENN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:620-223-0200
Mailing Address - Street 1:11184 ANTIOCH RD STE 356
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2420
Mailing Address - Country:US
Mailing Address - Phone:913-787-6724
Mailing Address - Fax:
Practice Address - Street 1:916 HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-8885
Practice Address - Country:US
Practice Address - Phone:620-223-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty