Provider Demographics
NPI:1114031028
Name:KAREN S ALDRIDGE
Entity Type:Organization
Organization Name:KAREN S ALDRIDGE
Other - Org Name:PRAIRIE WIND EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ALDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-421-3406
Mailing Address - Street 1:302 N POMEROY ST
Mailing Address - Street 2:
Mailing Address - City:HILL CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67642-1720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302 N POMEROY ST
Practice Address - Street 2:
Practice Address - City:HILL CITY
Practice Address - State:KS
Practice Address - Zip Code:67642-1720
Practice Address - Country:US
Practice Address - Phone:785-421-3406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAREN S ALDRIDGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-18
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS651128OtherBCBS
KS100219390AMedicaid
KS651128OtherBCBS
KS651128Medicare PIN
KS0647760001Medicare NSC
KSU35492Medicare UPIN