Provider Demographics
NPI:1770828410
Name:THE EYE CENTER OF SHAWNEE LLC
Entity Type:Organization
Organization Name:THE EYE CENTER OF SHAWNEE LLC
Other - Org Name:KC VISION CENTER LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JAYME
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-681-2624
Mailing Address - Street 1:8007 W 151ST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2115
Mailing Address - Country:US
Mailing Address - Phone:913-681-2624
Mailing Address - Fax:913-681-2628
Practice Address - Street 1:16100 W 65TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9301
Practice Address - Country:US
Practice Address - Phone:913-268-3300
Practice Address - Fax:913-268-3526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007035557152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty