Provider Demographics
NPI:1184696619
Name:BURCHETT, KARI L (OD)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:L
Last Name:BURCHETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KARI
Other - Middle Name:L
Other - Last Name:SPRAGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:OSAWATOMIE
Mailing Address - State:KS
Mailing Address - Zip Code:66064-0456
Mailing Address - Country:US
Mailing Address - Phone:913-256-2176
Mailing Address - Fax:913-755-2787
Practice Address - Street 1:524 BROWN AVE
Practice Address - Street 2:
Practice Address - City:OSAWATOMIE
Practice Address - State:KS
Practice Address - Zip Code:66064-1322
Practice Address - Country:US
Practice Address - Phone:913-256-2176
Practice Address - Fax:913-755-2787
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005020535152W00000X
KS1713152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200357920AMedicaid
KS36350032OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY
KSCA0104OtherRAILROAD MEDICARE
KSP00355811OtherRAILROAD MEDICARE
KS651077OtherMEDICARE ID-TYPE UNSPECIFIED
KSP0830623OtherRAILROAD MEDICARE
KSDQ3063OtherRAILROAD MEDICARE
KSKA1721003OtherMEDICARE ID-TYPE UNSPECIFIED
KS200357920DMedicaid
KSKA1721OtherMEDICARE ID-TYPE UNSPECIFIED
KS36350032OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY