Healthcare Provider Details

I. General information

NPI: 1235642620
Provider Name (Legal Business Name): ULYSSES EYECARE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W OKLAHOMA AVE
ULYSSES KS
67880-2359
US

IV. Provider business mailing address

747 R5 RD
PAWNEE ROCK KS
67567-6710
US

V. Phone/Fax

Practice location:
  • Phone: 620-356-4094
  • Fax: 620-285-9630
Mailing address:
  • Phone: 620-285-9630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberKS1472
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberKS2060
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS DUANE AYRE
Title or Position: OPTOMETRIST
Credential:
Phone: 620-285-2105