Provider Demographics
NPI:1720185366
Name:BAALMAN, KENT LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:LEE
Last Name:BAALMAN
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 1:982 N TYLER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3271
Mailing Address - Country:US
Mailing Address - Phone:316-722-6452
Mailing Address - Fax:316-722-6001
Practice Address - Street 1:982 N TYLER RD
Practice Address - Street 2:SUITE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3271
Practice Address - Country:US
Practice Address - Phone:316-722-6452
Practice Address - Fax:316-722-6001
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1293152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS032713001OtherDMERC
KS410018919OtherRAILROAD MEDICARE
KS032713001OtherDMERC
KS22451Medicare ID - Type Unspecified