Provider Demographics
NPI:1225106271
Name:NITSCHKE, DARIN L (OD)
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:L
Last Name:NITSCHKE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5834 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2419
Mailing Address - Country:US
Mailing Address - Phone:903-941-1882
Mailing Address - Fax:
Practice Address - Street 1:2200 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622-9206
Practice Address - Country:US
Practice Address - Phone:785-350-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1407152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100219940DMedicaid
KS20417050OtherBCBS OF KANSAS CITY
KS100219940CMedicaid
KS701951OtherBCBS OF KS
KS322231OtherFIRST GUARD
KS100219940DMedicaid
KS322231OtherFIRST GUARD
KS4025870002Medicare NSC