Provider Demographics
NPI:1083676936
Name:WICHITA OPTOMETRY, P.A.
Entity Type:Organization
Organization Name:WICHITA OPTOMETRY, P.A.
Other - Org Name:DRS. FISHER, YARROW, & FLEMING, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:YARROW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-942-7496
Mailing Address - Street 1:2635 W DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213
Mailing Address - Country:US
Mailing Address - Phone:316-942-7496
Mailing Address - Fax:316-942-9431
Practice Address - Street 1:2635 W DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213
Practice Address - Country:US
Practice Address - Phone:316-942-7496
Practice Address - Fax:316-239-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSCS8799Medicare PIN
KS0191150001Medicare NSC
KS650548Medicare PIN