Provider Demographics
NPI:1528037439
Name:SCHLETZBAUM OPTOMETRY, INC.
Entity Type:Organization
Organization Name:SCHLETZBAUM OPTOMETRY, INC.
Other - Org Name:DRS. TORRENCE AND SCHLETZBAUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCHLETZBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:620-663-4467
Mailing Address - Street 1:2311 N WALDRON ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1133
Mailing Address - Country:US
Mailing Address - Phone:620-663-4467
Mailing Address - Fax:620-663-5007
Practice Address - Street 1:2311 N WALDRON ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1133
Practice Address - Country:US
Practice Address - Phone:620-663-4467
Practice Address - Fax:620-663-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS950-3152W00000X, 152WC0802X
KS1663152W00000X, 152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100090370BMedicaid
KS649460OtherDR. T'S HEALTHWAVE KS
KS200252620AMedicaid
KS464910OtherDR. S'S HEALTHWAVE KS
DA0822OtherGROUP RAILROAD MEDICARE
4901160002OtherGROUP DMERC
P00072603OtherDR. T'S RAILROAD MEDICARE
P00016824OtherDR. S'S RAILROAD MEDICARE
T43698Medicare UPIN
650947Medicare ID - Type UnspecifiedDR. TORRENCE'S MEDICARE #
KS100090370BMedicaid
DA0822OtherGROUP RAILROAD MEDICARE
KS200252620AMedicaid
P00072603OtherDR. T'S RAILROAD MEDICARE