Active NPI
Miae Kwon, OD
- Optometrist
- Wichita, KS
National Provider Identifier
1104599414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPC5972
- Practice address
- 5500 E Kellogg Dr
Wichita, KS 67218-1607 - Phone
- (316) 685-2221
- NPI assigned
- Aug 1, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPC5972 | FL | Primary |
Addresses
Primary practice location
5500 E Kellogg Dr
Wichita, KS 67218-1607
Mailing address
12302 E Lincoln CT
Wichita, KS 67207-7001
Phone (727) 688-8653
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPC5972 | FL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627776000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627776000000",
"number": "1104599414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12302 E LINCOLN CT",
"city": "WICHITA",
"state": "KS",
"postal_code": "672077001",
"telephone_number": "727-688-8653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5500 E KELLOGG DR",
"city": "WICHITA",
"state": "KS",
"postal_code": "672181607",
"telephone_number": "316-685-2221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KWON",
"first_name": "MIAE",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-01",
"last_updated": "2021-08-01",
"certification_date": "2021-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPC5972",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.