Provider Demographics
NPI:1699000679
Name:RYAN J. KUEKER OD PA
Entity Type:Organization
Organization Name:RYAN J. KUEKER OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUEKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-889-4387
Mailing Address - Street 1:115 WEST 3RD STREET
Mailing Address - Street 2:P O BOX 8
Mailing Address - City:ONAGA
Mailing Address - State:KS
Mailing Address - Zip Code:66521-0008
Mailing Address - Country:US
Mailing Address - Phone:785-889-4387
Mailing Address - Fax:785-889-7112
Practice Address - Street 1:115 WEST 3RD STREET
Practice Address - Street 2:
Practice Address - City:ONAGA
Practice Address - State:KS
Practice Address - Zip Code:66521-0008
Practice Address - Country:US
Practice Address - Phone:785-889-4387
Practice Address - Fax:785-889-7112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RYAN J. KUEKER OD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty