Healthcare Provider Details

I. General information

NPI: 1841498789
Provider Name (Legal Business Name): HUTCHINSON CLINIC OPTICAL SHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N WALDRON ST
HUTCHINSON KS
67502-1131
US

IV. Provider business mailing address

2101 N WALDRON ST
HUTCHINSON KS
67502-1131
US

V. Phone/Fax

Practice location:
  • Phone: 620-669-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateKS

VIII. Authorized Official

Name: MICHAEL HARMS
Title or Position: CFO
Credential:
Phone: 620-669-2500