Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 304 E Ave A, Syracuse, Kansas |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1144329566 | NPI | - | NPPES |
100220380A | Medicaid | KS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 1428-2 (Kansas) | Primary |
Mailing Address | Practice Location Address |
---|---|
802 N Campus Dr, Garden City, KS 67846-6342 Ph: (620) 275-5375 | 304 E Ave A, Syracuse, KS 67878 Ph: (620) 384-7882 |