Provider Demographics
NPI:1760654800
Name:JAMES R. PACE, O.D., P.A.
Entity Type:Organization
Organization Name:JAMES R. PACE, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:REX
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-262-8476
Mailing Address - Street 1:1039 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2906
Mailing Address - Country:US
Mailing Address - Phone:316-262-8476
Mailing Address - Fax:316-262-8477
Practice Address - Street 1:1039 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2906
Practice Address - Country:US
Practice Address - Phone:316-262-8476
Practice Address - Fax:316-262-8477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS972-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS410044812OtherRAILROAD MEDICARE
KS63197OtherMISSOURI PACIFIC TRAVELER
KS4083937OtherAETNA
KS100090590BMedicaid
KS650799OtherBLUECROSS BLUE SHIELD
KSKA2262Medicare PIN
KST43720Medicare UPIN
KS410044812OtherRAILROAD MEDICARE
KS650799Medicare PIN