Healthcare Provider Details

I. General information

NPI: 1528037439
Provider Name (Legal Business Name): SCHLETZBAUM OPTOMETRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2311 N WALDRON ST
HUTCHINSON KS
67502-1133
US

IV. Provider business mailing address

2311 N WALDRON ST
HUTCHINSON KS
67502-1133
US

V. Phone/Fax

Practice location:
  • Phone: 620-663-4467
  • Fax: 620-663-5007
Mailing address:
  • Phone: 620-663-4467
  • Fax: 620-663-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1663
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number950-3
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1663
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1663
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1663
License Number StateKS
# 6
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number950-3
License Number StateKS

VIII. Authorized Official

Name: JEFFERY JOHN SCHLETZBAUM
Title or Position: OWNER
Credential: O.D.
Phone: 620-663-4467