Provider Demographics
NPI:1013019066
Name:KITCHEN, ERIC PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PAUL
Last Name:KITCHEN
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 1:6127 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4209
Mailing Address - Country:US
Mailing Address - Phone:316-685-0630
Mailing Address - Fax:316-685-1580
Practice Address - Street 1:6127 E. CENTRAL
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4209
Practice Address - Country:US
Practice Address - Phone:316-685-0630
Practice Address - Fax:316-685-1580
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1222-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSN516OtherPREFERRED HEALTH SYSTEMS
KS100218160AMedicaid
KS0316410001Medicare NSC
KS017023Medicare PIN
KSN516OtherPREFERRED HEALTH SYSTEMS