Provider Demographics
NPI:1124021084
Name:DOUGLAS E BALL OD PA
Entity Type:Organization
Organization Name:DOUGLAS E BALL OD PA
Other - Org Name:SOUTHWIND EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:WHITTREDGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:620-662-2355
Mailing Address - Street 1:3120 N PLUM ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2918
Mailing Address - Country:US
Mailing Address - Phone:620-662-2355
Mailing Address - Fax:620-662-1102
Practice Address - Street 1:3120 N PLUM ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2918
Practice Address - Country:US
Practice Address - Phone:620-662-2355
Practice Address - Fax:620-662-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS017082Medicare PIN
KS0262650001Medicare NSC