Provider Demographics
NPI:1154423242
Name:KUEKER, RYAN JENNINGS I (OD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JENNINGS
Last Name:KUEKER
Suffix:I
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-1635
Mailing Address - Country:US
Mailing Address - Phone:785-456-2236
Mailing Address - Fax:785-456-2570
Practice Address - Street 1:631 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1635
Practice Address - Country:US
Practice Address - Phone:785-456-2236
Practice Address - Fax:785-456-2570
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1718152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200357750AMedicaid
KSV06666Medicare UPIN
KS200357750AMedicaid