Provider Demographics
NPI:1952507527
Name:WHITESELL OPTOMETRY, PA
Entity Type:Organization
Organization Name:WHITESELL OPTOMETRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITESELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-592-2020
Mailing Address - Street 1:21900 S WEBSTER ST STE B
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-9609
Mailing Address - Country:US
Mailing Address - Phone:913-592-2020
Mailing Address - Fax:913-592-5232
Practice Address - Street 1:21900 S WEBSTER ST STE B
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:KS
Practice Address - Zip Code:66083-9609
Practice Address - Country:US
Practice Address - Phone:913-592-2020
Practice Address - Fax:913-278-0528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1315152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100644720AMedicaid
KS100644720AMedicaid
KSU05607Medicare UPIN