Provider Demographics
NPI:1891979407
Name:EYE SPECIALISTS OF ATCHISON, LLC
Entity Type:Organization
Organization Name:EYE SPECIALISTS OF ATCHISON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCK-KUNZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-367-4451
Mailing Address - Street 1:605 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:ATCHISON
Mailing Address - State:KS
Mailing Address - Zip Code:66002-2404
Mailing Address - Country:US
Mailing Address - Phone:913-367-4451
Mailing Address - Fax:913-367-7640
Practice Address - Street 1:605 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-2404
Practice Address - Country:US
Practice Address - Phone:913-367-4451
Practice Address - Fax:913-367-7640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0428552207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS6137080001Medicare NSC