Provider Demographics
NPI:1437194065
Name:TRUNECEK, SCOTT D (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:TRUNECEK
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 1:1530 S OLIVER ST
Mailing Address - Street 2:151
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-3240
Mailing Address - Country:US
Mailing Address - Phone:316-682-5507
Mailing Address - Fax:316-682-5507
Practice Address - Street 1:1530 S OLIVER ST
Practice Address - Street 2:151
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3240
Practice Address - Country:US
Practice Address - Phone:316-682-5507
Practice Address - Fax:316-682-5507
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1317152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100219910 DMedicaid