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General NPI Number Information
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NPI Number | 1760654800
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Entity Type | Organization
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Legal Business Name | JAMES R. PACE, O.D., P.A.
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 1039 N BROADWAY ST
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City | WICHITA
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State | KS
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Zip | 67214-2906
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Country | US
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Telephone | 316-262-8476
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Fax | 316-262-8477
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Provider Business Mailing Address
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Address Line | 1039 N BROADWAY ST
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City | WICHITA
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State | KS
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Zip | 67214-2906
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Country | US
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Telephone | 316-262-8476
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Fax | 316-262-8477
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Authorized Official
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Title or Position | PROPRIATOR
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Name | MR. JAMES REX PACE
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Credential | O.D.
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Telephone | 316-262-8476
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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 | 972-3
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License Number State | KS
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