Provider Demographics
NPI:1902060122
Name:MID KANSAS EYECARE, INC.
Entity Type:Organization
Organization Name:MID KANSAS EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:UNRUH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:620-327-2800
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:HESSTON
Mailing Address - State:KS
Mailing Address - Zip Code:67062-0696
Mailing Address - Country:US
Mailing Address - Phone:620-327-2800
Mailing Address - Fax:620-327-2055
Practice Address - Street 1:607 E RANDALL
Practice Address - Street 2:
Practice Address - City:HESSTON
Practice Address - State:KS
Practice Address - Zip Code:67062-0696
Practice Address - Country:US
Practice Address - Phone:620-327-2800
Practice Address - Fax:620-327-2055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11913261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS410040591OtherRAILROAD MEDICARE
KS1528035433Medicaid
KS200588540AMedicaid
KS6158050001Medicare NSC
KS200588540AMedicaid