Provider Demographics
NPI:1043290562
Name:ORSON, DAVID E (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:ORSON
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 1:4247 SW FLINTROCK DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4840
Mailing Address - Country:US
Mailing Address - Phone:816-537-6278
Mailing Address - Fax:
Practice Address - Street 1:3536 SW MARKET ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64082-2327
Practice Address - Country:US
Practice Address - Phone:816-537-0011
Practice Address - Fax:816-537-0402
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO3192152W00000X
KS1439152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO313833626Medicaid
U51662Medicare UPIN
MO313833626Medicaid