Provider Demographics
NPI:1538495866
Name:ECK FAMILY EYECARE, LLC
Entity type:Organization
Organization Name:ECK FAMILY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ECK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-268-3300
Mailing Address - Street 1:16100 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66217-9301
Mailing Address - Country:US
Mailing Address - Phone:913-268-3300
Mailing Address - Fax:913-268-3526
Practice Address - Street 1:16100 W 65TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217-9301
Practice Address - Country:US
Practice Address - Phone:913-268-3300
Practice Address - Fax:913-268-3526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1834152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200617020AMedicaid