Provider Demographics
NPI:1609033828
Name:LASIK-1 OF KANSAS CITY, P.A.
Entity Type:Organization
Organization Name:LASIK-1 OF KANSAS CITY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-455-2020
Mailing Address - Street 1:211 NE 54TH ST
Mailing Address - Street 2:STE. 200
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-4362
Mailing Address - Country:US
Mailing Address - Phone:816-413-4504
Mailing Address - Fax:816-413-4568
Practice Address - Street 1:211 NE 54TH ST
Practice Address - Street 2:STE. 200
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4362
Practice Address - Country:US
Practice Address - Phone:816-413-4500
Practice Address - Fax:816-413-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty