Healthcare Provider Details

I. General information

NPI: 1114036167
Provider Name (Legal Business Name): ROBERTS & JANASEK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 E DOUGLAS AVE SUITE 50
WICHITA KS
67206-2376
US

IV. Provider business mailing address

8150 E DOUGLAS AVE SUITE 50
WICHITA KS
67206-2376
US

V. Phone/Fax

Practice location:
  • Phone: 316-681-0991
  • Fax: 316-681-9931
Mailing address:
  • Phone: 316-681-0991
  • Fax: 316-681-9931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1201-2
License Number StateKS

VIII. Authorized Official

Name: MS. SHARON L LANG
Title or Position: OFFICE MANAGER
Credential:
Phone: 316-681-0991