Provider Demographics
NPI:1548228406
Name:COKINGTIN EYE CENTER PA
Entity Type:Organization
Organization Name:COKINGTIN EYE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALESTRIERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-491-3737
Mailing Address - Street 1:5520 COLLEGE BLVD
Mailing Address - Street 2:201
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1630
Mailing Address - Country:US
Mailing Address - Phone:913-491-3737
Mailing Address - Fax:913-469-6686
Practice Address - Street 1:3111 W 6TH ST
Practice Address - Street 2:FAMILY VISION CARE LAWRENCE
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3101
Practice Address - Country:US
Practice Address - Phone:913-491-3737
Practice Address - Fax:913-469-6686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO506050301Medicaid
KS110802OtherBCBS
31661011OtherBCBSKC
31661011OtherPHP
31661011OtherFREEDOM NETWORK
KS100449800AMedicaid
KS110802OtherBCBS
31661011OtherPHP