Provider Demographics
NPI:1518339050
Name:BAALMAN & ASSOCIATES EYE CARE CENTER LLC
Entity Type:Organization
Organization Name:BAALMAN & ASSOCIATES EYE CARE CENTER LLC
Other - Org Name:BAALMAN EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-772-6452
Mailing Address - Street 1:982 N TYLER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3271
Mailing Address - Country:US
Mailing Address - Phone:316-772-6452
Mailing Address - Fax:316-772-6001
Practice Address - Street 1:982 N TYLER RD
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3271
Practice Address - Country:US
Practice Address - Phone:316-772-6452
Practice Address - Fax:316-772-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS7521210001Medicare NSC