Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1633 | KS |
NPI | 1003813809 |
---|---|
Provider Name | Kevin K Trummel |
First Address | Lawrence, KS 66049-3101 |
Second Address | Lawrence, KS 66049-3101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 13/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U42215 | (02) | KS |