MEDICARE: KATER OPTOMETRIC SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	1239-2	KS
2	152WP0200X	Pediatric Optometrist	1239-2	KS
3	152WS0006X	Sports Vision Optometrist	1239-2	KS
4	152WV0400X	Vision Therapy Optometrist	1239-2	KS
5	152WX0102X	Occupational Vision Optometrist	1239-2	KS
6	152WL0500X	Low Vision Rehabilitation Optometrist	1239-2	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	651176	OTHER	KS	BCBS LEGACY NUMBER

General Provider Information

NPI Number	:	1194910869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATER OPTOMETRIC SERVICES LLC

Provider Business Mailing Address
First Line	:	12111 W MAPLE ST
Second Line	:	SUITE 125
City	:	WICHITA
State	:	KS
Zip	:	67235-8755
Country	:	US
Telephone Number	:	316-832-0026
Fax Number	:	316-832-0029

Provider Business Practice Location Address
First Line	:	1211 W MAPLE
Second Line	:	SUITE 125
City	:	WICHITA
State	:	KS
Zip	:	67235-8756
Country	:	US
Telephone Number	:	316-832-0026
Fax Number	:	316-832-0029

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. AMY BODEN
Credential	:
Telephone Number	:	316-832-0026

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	09/09/2010

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Directions to “KATER OPTOMETRIC SERVICES LLC ” Practice Location

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