Basic Information
| Provider Information | |||||||||
| NPI: | 1952845083 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DRS PRICE YOUNG ODLE & HORSCH PA | ||||||||
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| OtherOrganizationName: | THE EYE DOCTORS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12111 W MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672358755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168320088 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12111 W MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672358755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362004393 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2016 | ||||||||
| LastUpdateDate: | 06/07/2019 | ||||||||
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| AuthorizedOfficialLastName: | LONG | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | DISTRICT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7852720707 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.