Provider Demographics
NPI: | 1528265477 |
---|---|
Name: | DORA L FINNEY OD PA |
Entity type: | Organization |
Organization Name: | DORA L FINNEY OD PA |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | OPTOMETRIST BUSINESS OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DORA |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | FINNEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | OD, PA |
Authorized Official - Phone: | 620-624-4371 |
Mailing Address - Street 1: | 1401 W 15TH ST |
Mailing Address - Street 2: | |
Mailing Address - City: | LIBERAL |
Mailing Address - State: | KS |
Mailing Address - Zip Code: | 67901-2275 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 620-624-4371 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1401 W 15TH ST |
Practice Address - Street 2: | |
Practice Address - City: | LIBERAL |
Practice Address - State: | KS |
Practice Address - Zip Code: | 67901-2275 |
Practice Address - Country: | US |
Practice Address - Phone: | 620-624-4371 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-07-02 |
Last Update Date: | 2023-12-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KS | KS1681 | 152W00000X, 152W00000X |
152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X, 156FC0800X, 156FC0801X, 156FX1100X, 156FX1101X, 156FX1201X, 156FX1202X, 156FX1800X, 156FX1900X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Single Specialty | |
No | 152WL0500X | Eye and Vision Services Providers | Optometrist | Low Vision Rehabilitation | Group - Single Specialty |
No | 152WP0200X | Eye and Vision Services Providers | Optometrist | Pediatrics | Group - Single Specialty |
No | 152WS0006X | Eye and Vision Services Providers | Optometrist | Sports Vision | Group - Single Specialty |
No | 152WV0400X | Eye and Vision Services Providers | Optometrist | Vision Therapy | Group - Single Specialty |
No | 152WX0102X | Eye and Vision Services Providers | Optometrist | Occupational Vision | Group - Single Specialty |
No | 156FC0800X | Eye and Vision Services Providers | Technician/Technologist | Contact Lens | Group - Single Specialty |
No | 156FC0801X | Eye and Vision Services Providers | Technician/Technologist | Contact Lens Fitter | Group - Single Specialty |
No | 156FX1100X | Eye and Vision Services Providers | Technician/Technologist | Ophthalmic | Group - Single Specialty |
No | 156FX1101X | Eye and Vision Services Providers | Technician/Technologist | Ophthalmic Assistant | Group - Single Specialty |
No | 156FX1201X | Eye and Vision Services Providers | Technician/Technologist | Optometric Assistant | Group - Single Specialty |
No | 156FX1202X | Eye and Vision Services Providers | Technician/Technologist | Optometric Technician | Group - Single Specialty |
No | 156FX1800X | Eye and Vision Services Providers | Technician/Technologist | Optician | Group - Single Specialty |
No | 156FX1900X | Eye and Vision Services Providers | Technician/Technologist | Orthoptist | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
6192340001 | Medicare NSC | ||
065163 | Medicare PIN |