Provider Demographics
NPI:1386633923
Name:GARDEN CITY OPTOMETRISTS, P.A.
Entity Type:Organization
Organization Name:GARDEN CITY OPTOMETRISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ROXIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-276-3381
Mailing Address - Street 1:707 E KANSAS PLZ
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5866
Mailing Address - Country:US
Mailing Address - Phone:620-276-3381
Mailing Address - Fax:620-275-7507
Practice Address - Street 1:707 E KANSAS PLZ
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5866
Practice Address - Country:US
Practice Address - Phone:620-276-3381
Practice Address - Fax:620-275-7507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200358140AMedicaid
KS650519Medicare PIN
KS1039620001Medicare NSC