Healthcare Provider Details

I. General information

NPI: 1114940160
Provider Name (Legal Business Name): WESTERN KANSAS LOW VISION ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E WALNUT ST
GARDEN CITY KS
67846-5560
US

IV. Provider business mailing address

PO BOX 2671
GARDEN CITY KS
67846-8671
US

V. Phone/Fax

Practice location:
  • Phone: 620-275-4938
  • Fax: 620-275-5262
Mailing address:
  • Phone: 620-275-4938
  • Fax: 620-275-5262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State

VIII. Authorized Official

Name: TERESA M GUERRERO
Title or Position: BUSINESS OFFICE SUPERVISOR
Credential:
Phone: 620-275-4938