Provider Demographics
NPI:1588838619
Name:WICHITA EYECARE, P.A.
Entity Type:Organization
Organization Name:WICHITA EYECARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERIFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:940-696-2653
Mailing Address - Street 1:4206 KEMP BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2845
Mailing Address - Country:US
Mailing Address - Phone:940-696-2653
Mailing Address - Fax:
Practice Address - Street 1:4206 KEMP BLVD
Practice Address - Street 2:STE B
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2845
Practice Address - Country:US
Practice Address - Phone:940-696-2653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5971TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty