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NPI Code Detail

MEDICARE: KASILLA DEANN WILLIAMS

MEDICARE: KASILLA DEANN WILLIAMS
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
1156FX1201XOptometric Assistant Technician

General Provider Information

NPI Number : 1366122186
Entity Type Code : Individual
Provider Name (Legal Business Name) : KASILLA DEANN WILLIAMS
Provider Business Mailing Address
First Line : 5500 E KELLOGG DR
Second Line :
City : WICHITA
State : KS
Zip : 67218-1607
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 949 S GLENDALE ST
Second Line :
City : WICHITA
State : KS
Zip : 67218-3210
Country : US
Telephone Number : 316-685-2221
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2023
Last Update Date : 07/18/2023

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Directions to “ KASILLA DEANN WILLIAMS ” Practice Location

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