Provider Demographics
NPI:1891861894
Name:DAVIS, JOHN T (OD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:DAVIS
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 1:10120 W 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213
Mailing Address - Country:US
Mailing Address - Phone:913-339-9090
Mailing Address - Fax:913-339-6417
Practice Address - Street 1:10120 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213
Practice Address - Country:US
Practice Address - Phone:913-339-9090
Practice Address - Fax:913-339-6417
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1372152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00126436OtherRR MEDICARE FOR EYE ASSOCIATES OF OVERLAND PARK
KSR193435OtherMEDICARE PART B FOR EYE ASSOCIATES OF OVERLAND PARK
MO19196025OtherBCBKSC FOR EYE ASSOCIATES OF OLATHE
MO19196035OtherBCBSKC FOR EYE ASSOCIATES OF SHAWNEE
KS4613812OtherAETNA
KSR183435OtherMEDICARE PART B FOR EYE ASSOCIATES OF OLATHE
MO19196045OtherBCBSKC FOR EYE ASSOCIATES OF LEAWOOD
KSKA1109001OtherMEDICARE PART B FOR EYE ASSOCIATES OF LEAWOOD
KSP00109862OtherRR MEDICARE FOR EYE ASSOCIATES OF OLATHE
KSR173435OtherMEDICARE PART B FOR EYE ASSOCIATES OF SHAWNEE
MO19196015OtherBCBSKC FOR EYE ASSOCIATES OF OVERLAND PARK
KSR173435OtherMEDICARE PART B FOR EYE ASSOCIATES OF SHAWNEE
MO19196025OtherBCBKSC FOR EYE ASSOCIATES OF OLATHE
KSKA1109001OtherMEDICARE PART B FOR EYE ASSOCIATES OF LEAWOOD
U37031Medicare UPIN