Provider Demographics
NPI:1679826135
Name:HUTTON, RHONDA L (OD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:L
Last Name:HUTTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 WOODLAWN PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-1853
Mailing Address - Country:US
Mailing Address - Phone:785-764-4759
Mailing Address - Fax:
Practice Address - Street 1:2540 IOWA ST STE L
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-5754
Practice Address - Country:US
Practice Address - Phone:785-727-4235
Practice Address - Fax:785-331-4185
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015012018152W00000X
TX5564152W00000X
KS1520152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201069290BMedicaid