Provider Demographics
NPI:1821062852
Name:KRANNAWITTER, LEA A (OD)
Entity Type:Individual
Prefix:DR
First Name:LEA
Middle Name:A
Last Name:KRANNAWITTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:A
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:11065 PFLUMM RD.
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4030
Mailing Address - Country:US
Mailing Address - Phone:913-451-7007
Mailing Address - Fax:913-451-7009
Practice Address - Street 1:11065 PFLUMM RD.
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4030
Practice Address - Country:US
Practice Address - Phone:913-451-7007
Practice Address - Fax:913-451-7009
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1571152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSU83781Medicare UPIN
KSP64A378Medicare PIN