Provider Demographics
NPI:1689856452
Name:JANE WINKLER PHILBROOK, OD, PA
Entity Type:Organization
Organization Name:JANE WINKLER PHILBROOK, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/SECY
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:WINKLER
Authorized Official - Last Name:PHILBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-299-3548
Mailing Address - Street 1:7161 STATE AVE
Mailing Address - Street 2:PO BOX 12174
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-3001
Mailing Address - Country:US
Mailing Address - Phone:913-299-3548
Mailing Address - Fax:913-299-9830
Practice Address - Street 1:7161 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-3001
Practice Address - Country:US
Practice Address - Phone:913-299-3548
Practice Address - Fax:913-299-9830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1338152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100219020BMedicaid
U16468Medicare UPIN
KSB430000AMedicare PIN