Provider Demographics
NPI:1114818358
Name:ECK, JEWEL
Entity type:Individual
Prefix:
First Name:JEWEL
Middle Name:
Last Name:ECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 S HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2130
Mailing Address - Country:US
Mailing Address - Phone:316-685-1898
Mailing Address - Fax:316-685-4170
Practice Address - Street 1:321 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2130
Practice Address - Country:US
Practice Address - Phone:316-685-1898
Practice Address - Fax:316-685-4170
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2242152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist