Provider Demographics
NPI:1336112317
Name:MUNSON, JAYNA D (OD)
Entity Type:Individual
Prefix:DR
First Name:JAYNA
Middle Name:D
Last Name:MUNSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 S CENTENNIAL RD
Mailing Address - Street 2:
Mailing Address - City:ARKANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67005-9609
Mailing Address - Country:US
Mailing Address - Phone:918-694-1182
Mailing Address - Fax:
Practice Address - Street 1:520 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:ARKANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:67005-2228
Practice Address - Country:US
Practice Address - Phone:918-442-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1502459Medicaid
OKV06105Medicare UPIN