Provider Demographics
NPI:1144267287
Name:JACKSON COUNTY EYE CLINIC INC.
Entity type:Organization
Organization Name:JACKSON COUNTY EYE CLINIC INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN/CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEAFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-524-8900
Mailing Address - Street 1:221 NW MCNARY CT
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4011
Mailing Address - Country:US
Mailing Address - Phone:816-524-8900
Mailing Address - Fax:816-525-2042
Practice Address - Street 1:221 NW MCNARY CT
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4011
Practice Address - Country:US
Practice Address - Phone:816-524-8900
Practice Address - Fax:816-525-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02710152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0700420002OtherNORIDIAN
MOCI2551OtherMEDICARE RR
MO13228014OtherBCBS GROUP NUMBER
MO5790000BMedicare PIN