MEDICARE: WICHITA OPTOMETRY, P.A.

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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1427526821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WICHITA OPTOMETRY, P.A.

Provider Business Mailing Address
First Line	:	2635 W DOUGLAS AVE
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67213-2605
Country	:	US
Telephone Number	:	316-942-7496
Fax Number	:	316-239-2557

Provider Business Practice Location Address
First Line	:	12111 W MAPLE ST STE 125
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67235-8756
Country	:	US
Telephone Number	:	316-942-7496
Fax Number	:	316-239-2557

Authorized Official
Title or Position	:	OWNER
Name	:	JEFFREY H YARROW
Credential	:	OD
Telephone Number	:	316-942-7496

Provider Enumeration Date	:	11/05/2018
Last Update Date	:	06/30/2021

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