Provider Demographics
NPI:1659566271
Name:KEVIN CRAWFORD OD AND JEFF WELTMER OD PA
Entity Type:Organization
Organization Name:KEVIN CRAWFORD OD AND JEFF WELTMER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTION
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-782-4983
Mailing Address - Street 1:1295 E 151ST ST STE 3
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3429
Mailing Address - Country:US
Mailing Address - Phone:913-782-4983
Mailing Address - Fax:913-390-5663
Practice Address - Street 1:1295 E 151ST ST STE 3
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-3429
Practice Address - Country:US
Practice Address - Phone:913-782-4983
Practice Address - Fax:913-390-5663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1043-2152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0477880001OtherMEDICARE PTAN
1932131174OtherRAILROAD MEDICARE GROUP NPI
410046592OtherRAILROAD GROUP PTAN
0477880001Medicare NSC
0477880001OtherMEDICARE PTAN
KA1440Medicare PIN