Provider Demographics
NPI:1669480380
Name:JOYCE, GREGORY PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PAUL
Last Name:JOYCE
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 1216
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-1216
Mailing Address - Country:US
Mailing Address - Phone:316-321-4020
Mailing Address - Fax:316-321-0115
Practice Address - Street 1:201 N VINE ST
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2055
Practice Address - Country:US
Practice Address - Phone:316-321-4020
Practice Address - Fax:316-321-0115
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS1112-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS022396Medicare ID - Type Unspecified
KST44080Medicare UPIN
KS0403370001Medicare NSC