Provider Demographics
NPI:1528035433
Name:UNRUH, PAUL E (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:UNRUH
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:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:HESSTON
Mailing Address - State:KS
Mailing Address - Zip Code:67062-0696
Mailing Address - Country:US
Mailing Address - Phone:620-327-2800
Mailing Address - Fax:620-327-2055
Practice Address - Street 1:607 E RANDALL
Practice Address - Street 2:
Practice Address - City:HESSTON
Practice Address - State:KS
Practice Address - Zip Code:67062
Practice Address - Country:US
Practice Address - Phone:620-327-2800
Practice Address - Fax:620-327-2055
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1191-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS410040591OtherRAILROAD MEDICARE
KS100426720AMedicaid
KS6158050001Medicare NSC
KS410040591OtherRAILROAD MEDICARE
KS100426720AMedicaid