Provider Demographics
NPI:1821069220
Name:WEST WICHITA FAMILY OPTOMETRISTS
Entity Type:Organization
Organization Name:WEST WICHITA FAMILY OPTOMETRISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:KISSLING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-262-3716
Mailing Address - Street 1:1202 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-3916
Mailing Address - Country:US
Mailing Address - Phone:316-262-3716
Mailing Address - Fax:316-262-0784
Practice Address - Street 1:1202 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-3916
Practice Address - Country:US
Practice Address - Phone:316-262-3716
Practice Address - Fax:316-262-0784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS005347OtherBCBS
KSU37184Medicare UPIN
KST78470Medicare UPIN
KS017136Medicare ID - Type Unspecified
KST80146Medicare UPIN
KS0181170001Medicare NSC
KS005347OtherBCBS
KST43661Medicare UPIN
KSU35078Medicare UPIN
KS049878Medicare ID - Type Unspecified
KS005122Medicare ID - Type Unspecified
KS017034Medicare ID - Type Unspecified