Provider Demographics
NPI:1194782797
Name:MCKINNEY, RICK H (OD)
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:H
Last Name:MCKINNEY
Suffix:
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 1:216 N MERIDIAN RD
Mailing Address - Street 2:P.O. BOX 765
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-5119
Mailing Address - Country:US
Mailing Address - Phone:316-283-1310
Mailing Address - Fax:316-283-1864
Practice Address - Street 1:216 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-5119
Practice Address - Country:US
Practice Address - Phone:316-283-1310
Practice Address - Fax:316-283-1864
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1224-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS650502Medicare ID - Type Unspecified
KST71340Medicare UPIN
KS0201600001Medicare NSC