Provider Demographics
NPI:1649355975
Name:EYE ASSOCIATES OF WICHITA PA
Entity type:Organization
Organization Name:EYE ASSOCIATES OF WICHITA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOSTELLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-943-0433
Mailing Address - Street 1:4600 W KELLOGG DR
Mailing Address - Street 2:215
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2568
Mailing Address - Country:US
Mailing Address - Phone:316-943-0433
Mailing Address - Fax:
Practice Address - Street 1:4600 W KELLOGG
Practice Address - Street 2:SUITE 215
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209
Practice Address - Country:US
Practice Address - Phone:316-943-0433
Practice Address - Fax:316-943-0433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS650505Medicare PIN