Provider Demographics
NPI:1922096296
Name:BALL, DOUGLAS E (OD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:E
Last Name:BALL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 N PLUM ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2918
Mailing Address - Country:US
Mailing Address - Phone:620-662-2355
Mailing Address - Fax:620-662-1102
Practice Address - Street 1:3120 N PLUM ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2918
Practice Address - Country:US
Practice Address - Phone:620-662-2355
Practice Address - Fax:620-662-1102
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10443152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0262650001OtherDMERC
T43709Medicare UPIN
KS005228Medicare ID - Type Unspecified