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General NPI Number Information
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NPI Number | 1881680270
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Entity Type | Individual
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Provider Name | AMY RENEE GOERTZ O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/21/2005
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 12111 W MAPLE ST STE 125
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City | WICHITA
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State | KS
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Zip | 67235-8756
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Country | US
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Telephone | 316-832-0088
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Fax | 316-832-0029
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Provider Business Mailing Address
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Address Line | 11621 W 17TH ST N
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City | WICHITA
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State | KS
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Zip | 67212-6968
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Country | US
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Telephone | 316-260-9736
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Fax | 316-832-0029
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1683
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License Number State | KS
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