Provider Demographics
NPI:1356371363
Name:MANION, ANNETTE S (OD)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:S
Last Name:MANION
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:S
Other - Last Name:BUSCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3830 W 75TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-4128
Mailing Address - Country:US
Mailing Address - Phone:913-384-1441
Mailing Address - Fax:913-384-3437
Practice Address - Street 1:3830 W 75TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-4128
Practice Address - Country:US
Practice Address - Phone:913-384-1441
Practice Address - Fax:913-384-3437
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1447152W00000X
MOT03226152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO30606011OtherKANSAS CITY BC/BS
MO30606011OtherKANSAS CITY BC/BS
KS6508994Medicare ID - Type Unspecified
KSU58650Medicare UPIN
KS6508994EMedicare Oscar/Certification