Provider Demographics
NPI:1497933758
Name:HEATHER H. WOOTEN, O.D., P.A.
Entity Type:Organization
Organization Name:HEATHER H. WOOTEN, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:HANSON
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-733-5993
Mailing Address - Street 1:314 N GATEWAY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-7916
Mailing Address - Country:US
Mailing Address - Phone:316-733-5993
Mailing Address - Fax:
Practice Address - Street 1:2348 W CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-3464
Practice Address - Country:US
Practice Address - Phone:316-321-7732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1717152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSV07538Medicare UPIN