Provider Demographics
NPI:1356730766
Name:BLUE VALLEY VISION OF OVERLAND PARK LLC
Entity type:Organization
Organization Name:BLUE VALLEY VISION OF OVERLAND PARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-554-8582
Mailing Address - Street 1:8007 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2115
Mailing Address - Country:US
Mailing Address - Phone:785-554-8582
Mailing Address - Fax:
Practice Address - Street 1:8007 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2115
Practice Address - Country:US
Practice Address - Phone:785-554-8582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty