MEDICARE: HERO VISION OF WICHITA, 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	152W00000X	Optometrist	1796	KS

General Provider Information

NPI Number	:	1972782936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERO VISION OF WICHITA, LLC

Provider Business Mailing Address
First Line	:	1901 W 21ST ST N
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67203-2106
Country	:	US
Telephone Number	:	719-576-1850
Fax Number	:

Provider Business Practice Location Address
First Line	:	1255 LAKE PLAZA DR
Second Line	:	SUITE 270
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3500
Country	:	US
Telephone Number	:	719-576-1850
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHAEL G. PHARRIS
Credential	:	O.D.
Telephone Number	:	719-576-1850

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	10/26/2007

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