Provider Demographics
NPI:1245229848
Name:NIEGSCH, PAUL J (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:NIEGSCH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-0186
Mailing Address - Country:US
Mailing Address - Phone:620-232-3277
Mailing Address - Fax:620-231-6680
Practice Address - Street 1:101 N BROADWAY ST
Practice Address - Street 2:STE #A
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-4804
Practice Address - Country:US
Practice Address - Phone:620-232-3277
Practice Address - Fax:620-231-6680
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1242-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS618650OtherFIRST GUARD
KS60110OtherPREFERRED HEALTH SYSTEMS
KS4740220001OtherCIGNA
KS650906OtherBLUE CROSS BLUE SHIELD
KS60110OtherPREFERRED HEALTH SYSTEMS
KSU05517Medicare UPIN