Provider Demographics
NPI:1518903756
Name:CLINE, GINGER E (OD)
Entity Type:Individual
Prefix:DR
First Name:GINGER
Middle Name:E
Last Name:CLINE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 W 75TH ST STE 140
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-4001
Mailing Address - Country:US
Mailing Address - Phone:913-362-3210
Mailing Address - Fax:913-362-0407
Practice Address - Street 1:1147 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-5105
Practice Address - Country:US
Practice Address - Phone:816-322-6100
Practice Address - Fax:913-362-0407
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO-T03216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO22170038OtherBCBS-CC LOCATION
MO317966703Medicaid
NE22170028OtherBCBS-SL LOCATION
MO317966703Medicaid
MOJ067716Medicare PIN
MO180023221Medicare PIN
NE22170028OtherBCBS-SL LOCATION