Provider Demographics
NPI:1215105168
Name:J J PADFIELD
Entity type:Organization
Organization Name:J J PADFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:PADFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-448-6879
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-0346
Mailing Address - Country:US
Mailing Address - Phone:785-448-6879
Mailing Address - Fax:785-448-5522
Practice Address - Street 1:536 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1355
Practice Address - Country:US
Practice Address - Phone:785-448-6879
Practice Address - Fax:785-448-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS983-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0412770002Medicare NSC