Provider Demographics
NPI:1497802722
Name:RETTIG, ESTHER VIRGINIA (MD)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:VIRGINIA
Last Name:RETTIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:VIRGINIA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:901 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-2841
Mailing Address - Country:US
Mailing Address - Phone:620-245-0556
Mailing Address - Fax:620-245-0503
Practice Address - Street 1:901 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2841
Practice Address - Country:US
Practice Address - Phone:620-245-0556
Practice Address - Fax:620-245-0503
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0427129KS207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100291310CMedicaid
KSF-87754Medicare UPIN
KS100291310CMedicaid