Provider Demographics
NPI:1952440265
Name:BRINCKMAN, PAUL J (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:BRINCKMAN
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:PO BOX 3047
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66063-1047
Mailing Address - Country:US
Mailing Address - Phone:913-764-3937
Mailing Address - Fax:913-764-3947
Practice Address - Street 1:16124 W 135TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1517
Practice Address - Country:US
Practice Address - Phone:913-764-3937
Practice Address - Fax:913-764-3947
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS1543152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200335030AMedicaid
KSM90C002Medicare ID - Type Unspecified
KS200335030AMedicaid