Provider Demographics
NPI:1083852453
Name:WENTZ EYE CARE, P.A.
Entity Type:Organization
Organization Name:WENTZ EYE CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:WENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-243-3937
Mailing Address - Street 1:135 E 6TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:KS
Mailing Address - Zip Code:66901-2902
Mailing Address - Country:US
Mailing Address - Phone:785-243-3937
Mailing Address - Fax:785-243-3937
Practice Address - Street 1:135 E 6TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-2902
Practice Address - Country:US
Practice Address - Phone:785-243-3937
Practice Address - Fax:785-243-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS1563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS3186815102Medicaid
KS3186815102Medicaid
KS6225210001Medicare NSC
KSKA1318Medicare PIN