Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1394 | KS |
NPI | 1003881269 |
---|---|
Provider Name | Suzanne Buchanan |
First Address | Wichita, KS 67206-3413 |
Second Address | Wichita, KS 67205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 13/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100220270B | (05) | KS |
U50266 | (02) |