Healthcare Provider Details

I. General information

NPI: 1801999362
Provider Name (Legal Business Name): JAMES S JURY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 E DOUGLAS AVE
WICHITA KS
67202-3510
US

IV. Provider business mailing address

926 E DOUGLAS AVE
WICHITA KS
67202-3510
US

V. Phone/Fax

Practice location:
  • Phone: 316-247-6515
  • Fax: 678-928-0651
Mailing address:
  • Phone: 316-247-6515
  • Fax: 678-928-0651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1282-3
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1282
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1282
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number1282
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number1282
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number1282
License Number StateKS
# 7
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1282
License Number StateKS
# 8
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number1282
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: