Provider Demographics
NPI:1679186761
Name:MORRISON OPTOMETRIC ASSOCIATES PA
Entity Type:Organization
Organization Name:MORRISON OPTOMETRIC ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:F
Authorized Official - Last Name:WAHLMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-462-8231
Mailing Address - Street 1:1005 S RANGE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-3538
Mailing Address - Country:US
Mailing Address - Phone:785-462-8231
Mailing Address - Fax:785-462-2307
Practice Address - Street 1:105 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:CO
Practice Address - Zip Code:80759-1913
Practice Address - Country:US
Practice Address - Phone:970-848-5345
Practice Address - Fax:970-848-5346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORRISON OPTOMETRIC ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty