Provider Demographics
NPI:1003813809
Name:TRUMMEL, KEVIN K (OD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:K
Last Name:TRUMMEL
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 1:3111 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-3101
Mailing Address - Country:US
Mailing Address - Phone:785-841-5288
Mailing Address - Fax:785-749-2323
Practice Address - Street 1:3111 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-3101
Practice Address - Country:US
Practice Address - Phone:785-841-5288
Practice Address - Fax:785-749-2323
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1633152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS650874Medicare PIN
KSU42215Medicare UPIN
KS017158Medicare ID - Type Unspecified
KS0776480001Medicare NSC