Provider Demographics
NPI:1235642620
Name:ULYSSES EYECARE, PA
Entity Type:Organization
Organization Name:ULYSSES EYECARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:AYRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-285-2105
Mailing Address - Street 1:747 R5 RD
Mailing Address - Street 2:
Mailing Address - City:PAWNEE ROCK
Mailing Address - State:KS
Mailing Address - Zip Code:67567-6710
Mailing Address - Country:US
Mailing Address - Phone:620-285-9630
Mailing Address - Fax:
Practice Address - Street 1:1100 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2359
Practice Address - Country:US
Practice Address - Phone:620-356-4094
Practice Address - Fax:620-285-9630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS1472152W00000X
KSKS2060152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty