Provider Demographics
NPI:1871518555
Name:EYE SPECIALISTS ASSOCIATED, PA
Entity type:Organization
Organization Name:EYE SPECIALISTS ASSOCIATED, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:POKORNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-628-8218
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-0160
Mailing Address - Country:US
Mailing Address - Phone:785-628-8218
Mailing Address - Fax:785-628-8617
Practice Address - Street 1:2214 CANTERBURY DR
Practice Address - Street 2:STE. 312
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2386
Practice Address - Country:US
Practice Address - Phone:785-628-8218
Practice Address - Fax:785-628-8617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS003955OtherBCBS OF KANSAS
NE=========Medicaid
KS003955OtherBCBS OF KANSAS
NE098860Medicare ID - Type UnspecifiedPART B PROVIDER NUMBER
KS0326770001Medicare NSC