Provider Demographics
NPI:1700885860
Name:HERRIOTT, DOUGLAS GERARD (OD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:GERARD
Last Name:HERRIOTT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 NW MCNARY CT
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4011
Mailing Address - Country:US
Mailing Address - Phone:816-524-8900
Mailing Address - Fax:816-525-2042
Practice Address - Street 1:221 NW MCNARY CT
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4011
Practice Address - Country:US
Practice Address - Phone:816-524-8900
Practice Address - Fax:816-525-2042
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3842-35152W00000X
FLTPOP132152W00000X
DEI5-0000006152W00000X
MOT-02668152W00000X
KS1194-2152W00000X
MN3889152W00000X
NE1634152W00000X
UT13504640-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS410020656OtherRAILROAD MEDICARE
KS650867OtherMEDICARE ID-TYPE UNSPECIFIED
KSP00830624OtherRAILROAD MEDICARE
KS100218090BMedicaid
MO13233011OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY
MO410038120OtherMEDICARE RR
MO5797074BOtherMEDICARE ID - UNSPECIFIED
KS100218090AMedicaid
KSKA1721001OtherMEDICARE ID-TYPE UNSPECIFIED
KS100218090BMedicaid
KSP00830624OtherRAILROAD MEDICARE