Basic Information
| Provider Information | |||||||||
| NPI: | 1679850721 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSIGHT EYECARE SPECIALTIES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19045 EAST VALLEY VIEW PARKWAY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640559942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167957777 | ||||||||
| FaxNumber: | 8167951290 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 ENSIGN HILL DR | ||||||||
| Address2: | SUITE F | ||||||||
| City: | PLATTE CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640797836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164312202 | ||||||||
| FaxNumber: | 8164312205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2011 | ||||||||
| LastUpdateDate: | 11/03/2011 | ||||||||
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| AuthorizedOfficialLastName: | PHILLIPS | ||||||||
| AuthorizedOfficialFirstName: | CHAD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8167957777 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.