Provider Demographics
NPI:1194910869
Name:KATER OPTOMETRIC SERVICES LLC
Entity type:Organization
Organization Name:KATER OPTOMETRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-832-0026
Mailing Address - Street 1:12111 W MAPLE ST
Mailing Address - Street 2:SUITE 125
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-8755
Mailing Address - Country:US
Mailing Address - Phone:316-832-0026
Mailing Address - Fax:316-832-0029
Practice Address - Street 1:1211 W MAPLE
Practice Address - Street 2:SUITE 125
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-8756
Practice Address - Country:US
Practice Address - Phone:316-832-0026
Practice Address - Fax:316-832-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1239-2152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS651176OtherBCBS LEGACY NUMBER
KS651176OtherBCBS LEGACY NUMBER