Provider Demographics
NPI:1184616807
Name:ENIVISION INC
Entity type:Organization
Organization Name:ENIVISION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:P
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-425-7100
Mailing Address - Street 1:2301 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-4819
Mailing Address - Country:US
Mailing Address - Phone:316-682-4646
Mailing Address - Fax:316-263-4116
Practice Address - Street 1:2301 S WATER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-4819
Practice Address - Country:US
Practice Address - Phone:316-682-4646
Practice Address - Fax:316-263-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4698810001OtherCIGNA MEDICARE
4698810001OtherCIGNA MEDICARE
650553Medicare ID - Type Unspecified