Provider Demographics
NPI:1649209586
Name:HEART OF AMERICA EYE CARE, PA
Entity Type:Organization
Organization Name:HEART OF AMERICA EYE CARE, PA
Other - Org Name:SHAWNEE MISSION EYE CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:KWAPISZESKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-362-3210
Mailing Address - Street 1:8800 W 75TH ST STE 140
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-4001
Mailing Address - Country:US
Mailing Address - Phone:913-362-3210
Mailing Address - Fax:913-362-0407
Practice Address - Street 1:8800 W 75TH ST STE 140
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-4001
Practice Address - Country:US
Practice Address - Phone:913-362-3210
Practice Address - Fax:913-362-0407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10432019OtherBCBS OF KANSAS CITY, MO
MO10432019OtherBCBS OF KANSAS CITY, MO
KS0570000Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
KSCG7254Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP #