Provider Demographics
NPI:1003046756
Name:KUEKER, RICHARD JAY (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAY
Last Name:KUEKER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:KS
Mailing Address - Zip Code:66901-2817
Mailing Address - Country:US
Mailing Address - Phone:785-243-3386
Mailing Address - Fax:785-243-4640
Practice Address - Street 1:222 W 6TH ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-2817
Practice Address - Country:US
Practice Address - Phone:785-243-3386
Practice Address - Fax:785-243-4640
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1841152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1499Medicare PIN
KS6399630001Medicare NSC