Healthcare Provider Details

I. General information

NPI: 1013274240
Provider Name (Legal Business Name): MORRISON OPTOMETRIC ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 MAIN AVE
GOODLAND KS
67735-2943
US

IV. Provider business mailing address

1005 S RANGE AVE STE 100
COLBY KS
67701-3537
US

V. Phone/Fax

Practice location:
  • Phone: 785-899-3654
  • Fax: 785-462-2307
Mailing address:
  • Phone: 785-462-8231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1587
License Number StateKS

VIII. Authorized Official

Name: MARY SHOAFF
Title or Position: OFFICE MANAGER
Credential:
Phone: 785-462-8231