Provider Demographics
NPI:1043331622
Name:EYE ASSOCIATES OF LEAWOOD PA
Entity type:Organization
Organization Name:EYE ASSOCIATES OF LEAWOOD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:PENNIPEDE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-339-9090
Mailing Address - Street 1:10120 W 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213
Mailing Address - Country:US
Mailing Address - Phone:913-339-9090
Mailing Address - Fax:913-339-6417
Practice Address - Street 1:15069 NALL AVE
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66223
Practice Address - Country:US
Practice Address - Phone:913-825-2600
Practice Address - Fax:913-339-6417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO38365011OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY
MO38365011OtherBLUE CROSS BLUE SHIELD OF KANSAS CITY
KS5927950001Medicare NSC