Provider Demographics
NPI:1952686255
Name:INSIGHT EYECARE SPECIALTIES INC
Entity Type:Organization
Organization Name:INSIGHT EYECARE SPECIALTIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-795-7777
Mailing Address - Street 1:19045 EAST VALLEY VIEW PARKWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-9942
Mailing Address - Country:US
Mailing Address - Phone:816-795-7777
Mailing Address - Fax:816-795-1290
Practice Address - Street 1:19045 EAST VALLEY VIEW PARKWAY
Practice Address - Street 2:SUITE A
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-9942
Practice Address - Country:US
Practice Address - Phone:816-795-7777
Practice Address - Fax:816-795-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5232940003Medicare NSC