Provider Demographics
NPI:1629090097
Name:KASER, JOO WON L (OD)
Entity Type:Individual
Prefix:DR
First Name:JOO WON
Middle Name:L
Last Name:KASER
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 1:11500 W 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2002
Mailing Address - Country:US
Mailing Address - Phone:913-451-0001
Mailing Address - Fax:
Practice Address - Street 1:11500 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2002
Practice Address - Country:US
Practice Address - Phone:913-451-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023007228152W00000X
KS2158152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL502720037OtherMEDICARE PTAN
IL046009881Medicaid