Provider Demographics
NPI:1942291703
Name:GEIST, STEPHEN R (OD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:GEIST
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:STEVE
Other - Middle Name:R
Other - Last Name:GEIST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2251 N WOODLAWN BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3947
Mailing Address - Country:US
Mailing Address - Phone:316-686-6063
Mailing Address - Fax:316-686-4214
Practice Address - Street 1:2251 N WOODLAWN BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3947
Practice Address - Country:US
Practice Address - Phone:316-686-6063
Practice Address - Fax:316-686-4214
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1017-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100090790AMedicaid
KS1942291703OtherNORIDIAN
KS826580109OtherPALMETTO GBA-RR MEDICARE
KS480906080OtherCOMMERCIAL INSURANCES
KS100090790AMedicaid
KS017048Medicare ID - Type UnspecifiedINDIVIDUAL