Provider Demographics
NPI:1760536908
Name:EYE TO EYE PA
Entity Type:Organization
Organization Name:EYE TO EYE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRANSTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-788-9290
Mailing Address - Street 1:1105 N BUCKNER ST
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-2719
Mailing Address - Country:US
Mailing Address - Phone:316-788-9290
Mailing Address - Fax:316-788-6157
Practice Address - Street 1:1105 N BUCKNER ST
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-2719
Practice Address - Country:US
Practice Address - Phone:316-788-9290
Practice Address - Fax:316-788-6157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1002B516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100276150CMedicaid
051500Medicare PIN