Provider Demographics
NPI:1649223108
Name:YSIDRO, MONTANO (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:MONTANO
Middle Name:
Last Name:YSIDRO
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:MR
Other - First Name:MONTE
Other - Middle Name:
Other - Last Name:YSIDRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:606 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2026
Mailing Address - Country:US
Mailing Address - Phone:316-320-9680
Mailing Address - Fax:316-320-9680
Practice Address - Street 1:606 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2026
Practice Address - Country:US
Practice Address - Phone:316-320-9680
Practice Address - Fax:316-320-9680
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSNA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician