Provider Demographics
NPI:1831107374
Name:WOITASCZYK, THOMAS ERICH (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ERICH
Last Name:WOITASCZYK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-2220
Mailing Address - Country:US
Mailing Address - Phone:816-421-6940
Mailing Address - Fax:816-792-2351
Practice Address - Street 1:8301 N CHURCH RD
Practice Address - Street 2:WAL MART VISION CENTER
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1106
Practice Address - Country:US
Practice Address - Phone:816-792-4754
Practice Address - Fax:816-792-2351
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03237152W00000X
KS1471152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU63772Medicare UPIN
MO000E084Medicare ID - Type Unspecified