Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1841 | KS |
NPI | 1003046756 |
---|---|
Provider Name | Dr. Richard Jay Kueker |
First Address | Concordia, KS 66901-2817 |
Second Address | Concordia, KS 66901-2817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2009 |
Last Update Date | 01/11/2010 |