Provider Demographics
NPI:1497885271
Name:CHILD & FAMILY EYECARE PA
Entity type:Organization
Organization Name:CHILD & FAMILY EYECARE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:R
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:316-721-8877
Mailing Address - Street 1:746 N MAIZE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4571
Mailing Address - Country:US
Mailing Address - Phone:316-721-8877
Mailing Address - Fax:316-721-6762
Practice Address - Street 1:746 N MAIZE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4571
Practice Address - Country:US
Practice Address - Phone:316-721-8877
Practice Address - Fax:316-721-6762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200742310AMedicaid
KS200742310AMedicaid
KS0333040001Medicare NSC