Provider Demographics
NPI:1144339128
Name:VIERTHALER KESSEN, LOIS ANN (OD)
Entity type:Individual
Prefix:DR
First Name:LOIS
Middle Name:ANN
Last Name:VIERTHALER KESSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W ROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2133
Mailing Address - Country:US
Mailing Address - Phone:620-225-6500
Mailing Address - Fax:620-225-6597
Practice Address - Street 1:208 W ROSS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801
Practice Address - Country:US
Practice Address - Phone:620-225-6500
Practice Address - Fax:620-225-6597
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1378-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS650985OtherBLUE CROSS/BLUE SHIELD
KS0644920001Medicare NSC
KS650985OtherBLUE CROSS/BLUE SHIELD
KSU34589Medicare UPIN