Provider Demographics
NPI:1568466985
Name:GROSDIDIER, KELLY F (OD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:F
Last Name:GROSDIDIER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8300 COLLEGE BLVD.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210
Mailing Address - Country:US
Mailing Address - Phone:913-491-3330
Mailing Address - Fax:913-491-9650
Practice Address - Street 1:8300 COLLEGE BLVD.
Practice Address - Street 2:SUITE 201
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210
Practice Address - Country:US
Practice Address - Phone:913-491-3330
Practice Address - Fax:913-491-9650
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1427152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist