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General NPI Number Information
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NPI Number | 1649355975
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Entity Type | Organization
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Legal Business Name | EYE ASSOCIATES OF WICHITA PA
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 4600 W KELLOGG SUITE 215
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City | WICHITA
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State | KS
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Zip | 67209
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Country | US
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Telephone | 316-943-0433
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Fax | 316-943-0433
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Provider Business Mailing Address
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Address Line | 4600 W KELLOGG DR 215
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City | WICHITA
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State | KS
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Zip | 67209-2568
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Country | US
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Telephone | 316-943-0433
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Fax |
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Authorized Official
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Title or Position | OWNER OPTOMETRIST
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Name | CARLA J MOSTELLER
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Credential | OD
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Telephone | 316-943-0433
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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 |
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License Number State |
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