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General NPI Number Information
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NPI Number | 1598041899
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Entity Type | Organization
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Legal Business Name | THE EYE GALLERY, LLC
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Dates
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Enumeration Date | 10/31/2011
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Last Update Date | 10/31/2011
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Provider Practice Location Address
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Address Line | 2146 N COLLECTIVE LN #110
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City | WICHITA
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State | KS
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Zip | 67206-3573
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Country | US
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Telephone | 620-770-1493
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Fax |
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Provider Business Mailing Address
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Address Line | 4024 S GILDA CT
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City | WICHITA
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State | KS
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Zip | 67215-2052
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Country | US
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Telephone | 620-770-1493
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MEGAN BALDWIN
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Credential | O.D.
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Telephone | 620-770-1493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1889
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License Number State | KS
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