Ryan J. Kueker, OD, PA
Organization Active NPI Optometrist · Wamego, KS
NPI 1033201876 · NPPES record last updated Nov 24, 2008
Key facts
- NPI
- 1033201876
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 1718 (KS)
- Legal business name
- RYAN J. KUEKER, OD, PA
- Practice address
- 631 Lincoln St
Wamego, KS 66547-1635 - Phone
- (785) 456-2236
- Fax
- (785) 456-2570
- NPI assigned
- Sep 29, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Ryan Jennings Kueker, OD
- Title
- President/Owner
- Phone
- (785) 456-2236
Other NPIs on the same Medicare enrollment 1
Subparts reporting this organization as parent 1
Practitioners 7
-
Scott Michael Carpenter, O.D.
-
Ryan Jennings Kueker I, O.D.
-
Kassidy Nelson, OD
-
Christina A Windhorst, O.D.
-
Nicole J Wainwright, O.D.
-
Verne Claussen, OD
-
Richard Jay Kueker, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051004000313 | KS | Part B Supplier - Clinic/Group Practice | 7810922390 |
Receives reassigned benefits from 5 practitioners 1 other NPI on this enrollment Practice locations: Onaga, KS; Wamego, KS; Seneca, KS; Saint Marys, KS; Manhattan, KS |
National Provider Directory
Locations
8200 Southport Dr
Ste 108
Manhattan, KS 66502
Phone (785) 775-1514
33 S 4th St
Ste B
Seneca, KS 66538
Phone (785) 456-2236
520 Main St
Seneca, KS 66538
Phone (785) 456-2236
631 Lincoln Ave
Wamego, KS 66547
Phone (785) 456-2235
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 1718 | KS | Yes |
Addresses
Primary practice location
631 Lincoln St
Wamego, KS 66547-1635
Mailing address
PO Box 27
Wamego, KS 66547-0027
Phone (785) 456-2236
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200357750A | Medicaid | KS |
Other providers in Wamego, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 24, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.