Provider Demographics
NPI:1841351426
Name:RENNER, CHAD E (OD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:E
Last Name:RENNER
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 1:15345 W 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1074
Mailing Address - Country:US
Mailing Address - Phone:913-428-7911
Mailing Address - Fax:913-791-0197
Practice Address - Street 1:15345 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1074
Practice Address - Country:US
Practice Address - Phone:913-428-7911
Practice Address - Fax:913-791-0197
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002018357152W00000X
KS1782152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU92675Medicare UPIN
MO000C112Medicare ID - Type Unspecified