Basic Information
| Provider Information | |||||||||
| NPI: | 1396213799 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WICHITA OPTOMETRY, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2635 W DOUGLAS AVE | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672132605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3169427496 | ||||||||
| FaxNumber: | 3162392557 | ||||||||
| Practice Location | |||||||||
| Address1: | 2330 N AMIDON AVE | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672045630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3169427496 | ||||||||
| FaxNumber: | 3162392557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2018 | ||||||||
| LastUpdateDate: | 06/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | YARROW | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3169427496 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WICHITA OPTOMETRY P.A. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | 06/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.