Provider Demographics
NPI:1629038013
Name:PADFIELD, JERALD JOE (OD)
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:JOE
Last Name:PADFIELD
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 1:536 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-1355
Mailing Address - Country:US
Mailing Address - Phone:785-448-6879
Mailing Address - Fax:785-448-5522
Practice Address - Street 1:536 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1355
Practice Address - Country:US
Practice Address - Phone:785-448-6879
Practice Address - Fax:785-448-5522
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9833152W00000X
MOT02128152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
009568OtherARBO
KS312523030Medicaid
KS312523030Medicaid
T71282Medicare UPIN
KS0412770002Medicare NSC