Provider Demographics
NPI:1295770782
Name:RALSTON, ASHLEY (OD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:RALSTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E CENTRAL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-5604
Mailing Address - Country:US
Mailing Address - Phone:316-927-2200
Mailing Address - Fax:316-927-2343
Practice Address - Street 1:308 E CENTRAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002
Practice Address - Country:US
Practice Address - Phone:316-927-2200
Practice Address - Fax:316-927-2343
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1558152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100346090CMedicaid
KS100346090BMedicaid
KS005349002Medicare PIN
KS100346090CMedicaid
KS1295770782Medicare NSC
KSKA403303Medicare PIN
KS053987OtherBCBS