Provider Demographics
NPI:1710098892
Name:DR. DOUGLAS D. AYRE OPTOMETRIST P A
Entity Type:Organization
Organization Name:DR. DOUGLAS D. AYRE OPTOMETRIST P A
Other - Org Name:LARNED EYE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:AYRE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:620-285-2105
Mailing Address - Street 1:722 MANN AVE
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-2909
Mailing Address - Country:US
Mailing Address - Phone:620-285-2105
Mailing Address - Fax:620-285-7236
Practice Address - Street 1:722 MANN AVE
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-2909
Practice Address - Country:US
Practice Address - Phone:620-285-2105
Practice Address - Fax:620-285-7236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1472-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100281500DMedicaid
KS065081Medicare PIN
KS100281500DMedicaid