Provider Demographics
NPI:1427177625
Name:KANSAS VISION DEVELOPMENT CENTER
Entity type:Organization
Organization Name:KANSAS VISION DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:NUSZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-721-8877
Mailing Address - Street 1:746 N MAIZE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4571
Mailing Address - Country:US
Mailing Address - Phone:316-721-8877
Mailing Address - Fax:
Practice Address - Street 1:746 N MAIZE RD STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4571
Practice Address - Country:US
Practice Address - Phone:316-721-8877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSDR PIROTTE 1228-2152WV0400X
KSDR BAKER 1521152WV0400X
KSDR FISHER 1740152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS650808OtherBCBS OF KS DR PIROTTE
KS650809OtherBCBS OF KS DR BAKER
KS0650531OtherBCBS OF KS GROUP
KS650808OtherBCBS OF KS DR PIROTTE
KSU71298Medicare UPIN
KS0650531OtherBCBS OF KS GROUP