Provider Demographics
NPI:1528027372
Name:AMMEL, KATHLEEN VIOLA (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:VIOLA
Last Name:AMMEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 ATCHISON CIR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3950
Mailing Address - Country:US
Mailing Address - Phone:785-727-9759
Mailing Address - Fax:785-242-7300
Practice Address - Street 1:2101 S PRINCETON ST
Practice Address - Street 2:SUITE #100
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-4007
Practice Address - Country:US
Practice Address - Phone:785-242-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002796B152W00000X
KS1729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11357975OtherCAQH
IN200320070Medicaid
KS200400380AMedicaid
IN200320070Medicaid