=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811076060
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRS DRIVER & CLARK PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2006
-----------------------------------------------------
Last Update Date | 06/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 E IRON AVE
-----------------------------------------------------
City | SALINA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67401-3237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-825-4679
-----------------------------------------------------
Fax | 785-825-5898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 E IRON AVE
-----------------------------------------------------
City | SALINA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67401-3237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-825-4679
-----------------------------------------------------
Fax | 785-825-5898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. KENTON RAY DRIVER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 785-825-4679
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | KS1325
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------