Grant Derril Gwinner, O.D.
Individual provider Active NPI Optometrist · Ellsworth, KS
NPI 1063496362 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1063496362
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- KS9613 (KS)
- Practice address
- 801 E 3Rd St
Ellsworth, KS 67439-4224 - Phone
- (785) 472-3272
- Fax
- (785) 472-3360
- NPI assigned
- Dec 1, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KS9613 | KS | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| G Derril Gwinner, O.D. L.L.C. | Optometrist | Past | Accepting new patients |
| G Derril Gwinner OD LLC | Optometrist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | KS9613 | KS | Yes |
Addresses
Primary practice location
801 E 3Rd St
Ellsworth, KS 67439-4224
Mailing address
801 E 3Rd St
Ellsworth, KS 67439-4224
Phone (785) 472-3272
Other providers in Ellsworth, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.