Provider Demographics
NPI:1033201876
Name:RYAN J. KUEKER, OD, PA
Entity Type:Organization
Organization Name:RYAN J. KUEKER, OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JENNINGS
Authorized Official - Last Name:KUEKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-456-2236
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-0027
Mailing Address - Country:US
Mailing Address - Phone:785-456-2236
Mailing Address - Fax:785-456-2570
Practice Address - Street 1:631 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1635
Practice Address - Country:US
Practice Address - Phone:785-456-2236
Practice Address - Fax:785-456-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1718152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200357750AMedicaid
KS5554950001Medicare NSC
KSV06666Medicare UPIN
KS200357750AMedicaid