Provider Demographics
NPI:1629209051
Name:KANNARR EYE CARE, LLC
Entity Type:Organization
Organization Name:KANNARR EYE CARE, LLC
Other - Org Name:KANNARR EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:KANNARR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:620-235-1737
Mailing Address - Street 1:101 W 29TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-2696
Mailing Address - Country:US
Mailing Address - Phone:620-235-1737
Mailing Address - Fax:620-230-0358
Practice Address - Street 1:2521 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-2620
Practice Address - Country:US
Practice Address - Phone:620-235-1737
Practice Address - Fax:620-230-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1699152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6353760001Medicare NSC
U81481Medicare UPIN
KS1500Medicare PIN