Provider Demographics
NPI:1043207236
Name:FOSTER, WENDY RUNYON (OD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:RUNYON
Last Name:FOSTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:HOWERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2020 N WOODLAWN ST
Mailing Address - Street 2:STE 390
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1852
Mailing Address - Country:US
Mailing Address - Phone:316-682-9891
Mailing Address - Fax:316-682-9829
Practice Address - Street 1:2020 N WOODLAWN ST
Practice Address - Street 2:STE 390
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-1852
Practice Address - Country:US
Practice Address - Phone:316-682-9891
Practice Address - Fax:316-682-9829
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1560152W00000X
MOT03465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100317350BMedicaid
KS100317350BMedicaid