Provider Demographics
NPI:1871617787
Name:BRILL, RAYMOND J (OD, FAAO, FOAA)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:J
Last Name:BRILL
Suffix:
Gender:M
Credentials:OD, FAAO, FOAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 LAMAR AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-2647
Mailing Address - Country:US
Mailing Address - Phone:913-432-7676
Mailing Address - Fax:913-432-7717
Practice Address - Street 1:5820 LAMAR AVE STE 100
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-2647
Practice Address - Country:US
Practice Address - Phone:913-432-7676
Practice Address - Fax:913-432-7717
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1132-3152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100219700BMedicaid
KST42372Medicare UPIN
KSP760776Medicare PIN
KST42372Medicare UPIN