Provider Demographics
NPI:1821118415
Name:DOERKSEN & ASSOCIATES INC
Entity Type:Organization
Organization Name:DOERKSEN & ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOERKSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-721-3377
Mailing Address - Street 1:7570 W 21ST ST N
Mailing Address - Street 2:BLDG. 1002
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1734
Mailing Address - Country:US
Mailing Address - Phone:316-721-3377
Mailing Address - Fax:316-721-6077
Practice Address - Street 1:7570 W 21ST ST N
Practice Address - Street 2:BLDG. 1002
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1734
Practice Address - Country:US
Practice Address - Phone:316-721-3377
Practice Address - Fax:316-721-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS049835OtherBLUE CROSS
3712OtherPREFERRED HEALTH
KS462231Medicaid
KS462231Medicaid
KS049835Medicare ID - Type Unspecified
KS462231Medicaid