Provider Demographics
NPI:1104316439
Name:MORRISON OPTOMETRIC ASSOCIATES PA
Entity type:Organization
Organization Name:MORRISON OPTOMETRIC ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:F
Authorized Official - Last Name:WAHLMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:785-462-8231
Mailing Address - Street 1:1005 S RANGE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-3537
Mailing Address - Country:US
Mailing Address - Phone:785-462-8231
Mailing Address - Fax:785-462-2307
Practice Address - Street 1:210 CENTER AVE
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:KS
Practice Address - Zip Code:67748-1714
Practice Address - Country:US
Practice Address - Phone:785-672-4271
Practice Address - Fax:785-462-2307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MORRISON OPTOMETRIC ASSOCIATES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100219880AMedicaid