Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1222-3 | KS |
NPI | 1013019066 |
---|---|
Provider Name | Dr. Eric Paul Kitchen |
First Address | Wichita, KS 67208-4209 |
Second Address | Wichita, KS 67208-4209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 29/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100218160A | (05) | KS |
N516 | PREFERRED HEALTH SYSTEMS (01) | KS |
T77141 | (02) | KS |