Provider Demographics
NPI:1710958145
Name:FLINTHILLS EYECARE ASSOCIATES PA
Entity Type:Organization
Organization Name:FLINTHILLS EYECARE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GILAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:COCKRELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:620-343-7120
Mailing Address - Street 1:512 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-4006
Mailing Address - Country:US
Mailing Address - Phone:620-343-7120
Mailing Address - Fax:620-343-2038
Practice Address - Street 1:512 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-4006
Practice Address - Country:US
Practice Address - Phone:620-343-7120
Practice Address - Fax:620-343-2038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS017065OtherBCBS GROUP
KS017065OtherBCBS GROUP
KS650514Medicare ID - Type UnspecifiedGROUP
KS017143Medicare ID - Type UnspecifiedGROUP
KS065127Medicare ID - Type UnspecifiedGROUP
KS0632550001Medicare NSC