Basic Information
| Provider Information | |||||||||
| NPI: | 1164597118 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MULVANE VISION CARE,P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 SE LOUIS DR | ||||||||
| Address2: | |||||||||
| City: | MULVANE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671101205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167770022 | ||||||||
| FaxNumber: | 3167774342 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 SE LOUIS DR | ||||||||
| Address2: | |||||||||
| City: | MULVANE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671101205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167770022 | ||||||||
| FaxNumber: | 3167774342 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 12/14/2007 | ||||||||
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| AuthorizedOfficialLastName: | CLINE | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3167770022 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WV0400X | 1295 | KS | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Vision Therapy |
No ID Information.