Provider Demographics
NPI:1245339217
Name:SPEAK, SHERI LYNNE (OD)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:LYNNE
Last Name:SPEAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8532 W 135TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-1212
Mailing Address - Country:US
Mailing Address - Phone:913-851-2010
Mailing Address - Fax:
Practice Address - Street 1:8532 W 135TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-1212
Practice Address - Country:US
Practice Address - Phone:913-851-2010
Practice Address - Fax:913-948-9864
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS 1469-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKS 1469-3OtherSTATE LICENSE
MOT03176OtherMISSOURI LICENSE
MOT03176OtherMISSOURI LICENSE
MOT03176OtherMISSOURI LICENSE
KSU51664Medicare UPIN