Provider Demographics
NPI:1902023732
Name:EYEWORKS EYEWEAR SHOPPE
Entity Type:Organization
Organization Name:EYEWORKS EYEWEAR SHOPPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:DOEBELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-871-7053
Mailing Address - Street 1:245 N HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4903
Mailing Address - Country:US
Mailing Address - Phone:316-682-2683
Mailing Address - Fax:316-682-2683
Practice Address - Street 1:245 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4903
Practice Address - Country:US
Practice Address - Phone:316-682-2683
Practice Address - Fax:316-682-2683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service