Provider Demographics
NPI:1922183151
Name:VISION THERAPY OF WICHITA, INC.
Entity Type:Organization
Organization Name:VISION THERAPY OF WICHITA, INC.
Other - Org Name:WICHITA VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-832-0088
Mailing Address - Street 1:12111 W MAPLE ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-8755
Mailing Address - Country:US
Mailing Address - Phone:316-832-0088
Mailing Address - Fax:316-832-0029
Practice Address - Street 1:12111 W MAPLE ST
Practice Address - Street 2:SUITE 125
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-8755
Practice Address - Country:US
Practice Address - Phone:316-832-0088
Practice Address - Fax:316-832-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1295152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100218790DMedicaid
KS651061Medicare ID - Type Unspecified
KS100218790DMedicaid