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General NPI Number Information
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NPI Number | 1821118415
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Entity Type | Organization
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Legal Business Name | DOERKSEN & ASSOCIATES INC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 7570 W 21ST ST N BLDG. 1002
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City | WICHITA
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State | KS
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Zip | 67205-1734
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Country | US
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Telephone | 316-721-3377
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Fax | 316-721-6077
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Provider Business Mailing Address
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Address Line | 7570 W 21ST ST N BLDG. 1002
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City | WICHITA
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State | KS
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Zip | 67205-1734
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Country | US
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Telephone | 316-721-3377
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Fax | 316-721-6077
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Authorized Official
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Title or Position | OWNER
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Name | RUSSELL L DOERKSEN
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Credential | O.D.
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Telephone | 316-721-3377
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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 | 1324
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License Number State | KS
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