Provider Demographics
NPI:1962669291
Name:ULYSSES EYECARE, L.L.C.
Entity Type:Organization
Organization Name:ULYSSES EYECARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:620-356-4094
Mailing Address - Street 1:1100 W OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:KS
Mailing Address - Zip Code:67880-2359
Mailing Address - Country:US
Mailing Address - Phone:620-356-4094
Mailing Address - Fax:620-356-1978
Practice Address - Street 1:1100 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2359
Practice Address - Country:US
Practice Address - Phone:620-356-4094
Practice Address - Fax:620-356-1978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1026-3261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100219550CMedicaid