Provider Demographics
NPI:1952576563
Name:CHANUTE EYE CARE PA
Entity Type:Organization
Organization Name:CHANUTE EYE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:VIETTI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:620-431-0010
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-0307
Mailing Address - Country:US
Mailing Address - Phone:620-431-0010
Mailing Address - Fax:620-431-6959
Practice Address - Street 1:32 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-1701
Practice Address - Country:US
Practice Address - Phone:620-431-0010
Practice Address - Fax:620-431-6959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10623152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100091080AMedicaid
826580215OtherR R MEDICARE
826580215OtherR R MEDICARE
T43750Medicare UPIN
005308Medicare PIN