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General NPI Number Information
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NPI Number | 1023835683
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Entity Type | Organization
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Legal Business Name | EYE CONNECT VISION THERAPY
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Dates
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Enumeration Date | 09/25/2024
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 12330 E 21ST ST N STE B
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City | WICHITA
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State | KS
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Zip | 67206-3596
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Country | US
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Telephone | 316-712-5763
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Fax |
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Provider Business Mailing Address
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Address Line | 12330 E 21ST ST N STE B
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City | WICHITA
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State | KS
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Zip | 67206-3596
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Country | US
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Telephone | 316-712-5763
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MEGAN BALDWIN
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Credential | OD
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Telephone | 316-712-5763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number |
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License Number State |
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