Provider Demographics
NPI:1083884647
Name:STOREY, RYAN JAY
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:JAY
Last Name:STOREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 S SENECA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67217-3209
Mailing Address - Country:US
Mailing Address - Phone:316-524-3033
Mailing Address - Fax:316-524-2633
Practice Address - Street 1:3033 S SENECA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67217-3209
Practice Address - Country:US
Practice Address - Phone:316-524-3033
Practice Address - Fax:316-524-2633
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS5002710001Medicare UPIN