| NPI | 1225240591 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERYL DAVENPORT Insurance Department Supervisor 316-858-3831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 207W00000X Ophthalmology |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2008-02-20 |