=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891421400
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAYLOR FELLOWS OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2022
-----------------------------------------------------
Last Update Date | 02/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 E MAIN ST
-----------------------------------------------------
City | VALLEY CENTER
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67147-2153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 131-675-5049
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2323 OHIO ST
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67010-2153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-775-6341
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2172
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------