1528037439 NPI number — SCHLETZBAUM OPTOMETRY, INC.

Table of content: (NPI 1528037439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528037439 NPI number — SCHLETZBAUM OPTOMETRY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHLETZBAUM OPTOMETRY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DRS. TORRENCE AND SCHLETZBAUM
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528037439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2311 N WALDRON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUTCHINSON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67502-1133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-663-4467
Provider Business Mailing Address Fax Number:
620-663-5007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2311 N WALDRON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUTCHINSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67502-1133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-663-4467
Provider Business Practice Location Address Fax Number:
620-663-5007
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHLETZBAUM
Authorized Official First Name:
JEFFERY
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
620-663-4467

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  950-3 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 1663 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WC0802X , with the licence number: 950-3 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WC0802X , with the licence number: 1663 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , with the licence number: 1663 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WV0400X , with the licence number: 1663 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100090370B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 649460 . This is a "DR. T'S HEALTHWAVE KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 200252620A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 464910 . This is a "DR. S'S HEALTHWAVE KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: DA0822 . This is a "GROUP RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4901160002 . This is a "GROUP DMERC" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00072603 . This is a "DR. T'S RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00016824 . This is a "DR. S'S RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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