Healthcare Provider Details

I. General information

NPI: 1962669291
Provider Name (Legal Business Name): ULYSSES EYECARE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 11/25/2008
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

1100 W OKLAHOMA AVE
ULYSSES KS
67880-2359
US

V. Phone/Fax

Practice location:
  • Phone: 620-356-4094
  • Fax: 620-356-1978
Mailing address:
  • Phone: 620-356-4094
  • Fax: 620-356-1978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1026-3
License Number StateKS

VIII. Authorized Official

Name: GREGORY COPELAND
Title or Position: OPTOMETRIST/OWNER
Credential: D.O.
Phone: 620-356-4094