Provider Demographics
NPI:1598041899
Name:THE EYE GALLERY, LLC
Entity type:Organization
Organization Name:THE EYE GALLERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:620-770-1493
Mailing Address - Street 1:4024 S GILDA CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67215-2052
Mailing Address - Country:US
Mailing Address - Phone:620-770-1493
Mailing Address - Fax:
Practice Address - Street 1:2146 N COLLECTIVE LN
Practice Address - Street 2:#110
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3573
Practice Address - Country:US
Practice Address - Phone:620-770-1493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1889152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty