Provider Demographics
NPI:1649290255
Name:HEART OF AMERICA EYE CARE PA
Entity type:Organization
Organization Name:HEART OF AMERICA EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:KWAPISZESKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-362-3210
Mailing Address - Street 1:10985 CODY ST STE 120
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1243
Mailing Address - Country:US
Mailing Address - Phone:913-492-0021
Mailing Address - Fax:913-492-0093
Practice Address - Street 1:10985 CODY ST STE 120
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1243
Practice Address - Country:US
Practice Address - Phone:913-492-0021
Practice Address - Fax:913-492-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0417539207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO23482016OtherBCBS KC GR NUMBER
KSC52154Medicare UPIN
MO23482016OtherBCBS KC GR NUMBER
KS0786050002Medicare ID - Type UnspecifiedDEMERC GR NUMBER
KSCG0618Medicare ID - Type UnspecifiedRR MC GR NUMBER
KS0786050002Medicare NSC