Provider Demographics
NPI:1114940160
Name:WESTERN KANSAS LOW VISION ASSOCIATES PA
Entity Type:Organization
Organization Name:WESTERN KANSAS LOW VISION ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-275-4938
Mailing Address - Street 1:PO BOX 2671
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-8671
Mailing Address - Country:US
Mailing Address - Phone:620-275-4938
Mailing Address - Fax:620-275-5262
Practice Address - Street 1:310 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5560
Practice Address - Country:US
Practice Address - Phone:620-275-4938
Practice Address - Fax:620-275-5262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100398420AMedicaid
KS100398420AMedicaid
KS017081Medicare ID - Type Unspecified