Provider Demographics
NPI:1821668799
Name:WICHITA OPTOMETRY P.A.
Entity Type:Organization
Organization Name:WICHITA OPTOMETRY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:YARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-942-7496
Mailing Address - Street 1:2635 W DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-2605
Mailing Address - Country:US
Mailing Address - Phone:316-942-7496
Mailing Address - Fax:316-239-2557
Practice Address - Street 1:8150 E DOUGLAS AVE STE 50
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2362
Practice Address - Country:US
Practice Address - Phone:316-942-7496
Practice Address - Fax:316-239-2557
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WICHITA OPTOMETRY P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty