Provider Demographics
NPI:1851309074
Name:CAVANAUGH EYE CENTER, PA
Entity Type:Organization
Organization Name:CAVANAUGH EYE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:CAVANAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-897-9200
Mailing Address - Street 1:6200 W 135TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-4844
Mailing Address - Country:US
Mailing Address - Phone:913-897-9200
Mailing Address - Fax:913-897-9233
Practice Address - Street 1:6200 W 135TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-4844
Practice Address - Country:US
Practice Address - Phone:913-897-9200
Practice Address - Fax:913-897-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0423515207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO37891017OtherBCBS KC
KSN520000Medicare PIN
KS110924Medicare PIN
MO37891017OtherBCBS KC
KSE45617Medicare UPIN