Healthcare Provider Details

I. General information

NPI: 1679186761
Provider Name (Legal Business Name): MORRISON OPTOMETRIC ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S MAIN ST
YUMA CO
80759-1913
US

IV. Provider business mailing address

1005 S RANGE AVE STE 100
COLBY KS
67701-3538
US

V. Phone/Fax

Practice location:
  • Phone: 970-848-5345
  • Fax: 970-848-5346
Mailing address:
  • Phone: 785-462-8231
  • Fax: 785-462-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MARK F WAHLMEIER
Title or Position: OWNER
Credential: OD
Phone: 785-462-8231