Organization
RETINA ASSOCIATES LLC
Active
Organization
RETINA ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BLAKE A COOPER MD (OWNER)
(913) 831-7400
Entity
Organization
Contact information
Practice address
8600 QUIVIRA RD STE 100, LENEXA, KS 66215-2857
(913) 831-7400
(913) 831-7409
Mailing address
8600 QUIVIRA RD STE 100, LENEXA, KS 66215-2857
(913) 831-7400
(913) 831-7409
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
207WX0107X
Retina Specialist (Ophthalmology) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100342190A
—
KS
01
—
110601
BLUE CROSS BLUE SHIELD OF
KS
01
—
25646013
BLUE CROSS BLUE SHIELD OF
MO
05
—
505323600
—
MO
01
—
CB2776
RAILROAD MEDICARE
KS
01
—
CB2777
RAILROAD MEDICARE
MO
Enumeration date
06/12/2006
Last updated
08/17/2023
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