Provider Demographics
NPI:1063790145
Name:BALDWIN, MEGAN NICHOLE (OD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:NICHOLE
Last Name:BALDWIN
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 1:12330 E 21ST ST N STE A
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3596
Mailing Address - Country:US
Mailing Address - Phone:316-315-0321
Mailing Address - Fax:316-315-0325
Practice Address - Street 1:2146 N COLLECTIVE LN
Practice Address - Street 2:110
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3573
Practice Address - Country:US
Practice Address - Phone:620-770-1493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-24
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1889152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist