Provider Demographics
NPI:1982664363
Name:NORTHWEST KANSAS EYE CLINIC
Entity Type:Organization
Organization Name:NORTHWEST KANSAS EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HOLWEGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-625-4363
Mailing Address - Street 1:2503 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2233
Mailing Address - Country:US
Mailing Address - Phone:785-625-4363
Mailing Address - Fax:785-625-4894
Practice Address - Street 1:2503 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2233
Practice Address - Country:US
Practice Address - Phone:785-625-4363
Practice Address - Fax:785-625-4894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSDG7966OtherRAILROAD MEDICARE
KS165153OtherBCBS
KSDG7966OtherRAILROAD MEDICARE