G Derril Gwinner OD LLC
Organization Active NPI Optometrist · Ellsworth, KS
NPI 1144495490 · NPPES record last updated Apr 28, 2008
Key facts
- NPI
- 1144495490
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 9613 (KS)
- Legal business name
- G DERRIL GWINNER OD LLC
- Practice address
- 801 E 3Rd St
Ellsworth, KS 67439-4224 - Phone
- (785) 472-3272
- Fax
- (785) 472-3360
- NPI assigned
- Apr 28, 2008
- Organization subpart
- No
Authorized official
- Name
- Mr. G Derril Gwinner, OD
- Title
- Optometrist
- Phone
- (785) 472-3272
Corporate family (same tax ID) 1
Practitioners 2
-
Grant Derril Gwinner, O.D.
-
Grant K Gwinner, O.D.
National Provider Directory
- Tax ID family
- G Derril Gwinner OD LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 9613 | KS | Yes |
Addresses
Primary practice location
801 E 3Rd St
Ellsworth, KS 67439-4224
Mailing address
PO Box 339
Ellsworth, KS 67439-0339
Phone (785) 472-3272
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100090550A | Medicaid | KS |
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 Apr 28, 2008. 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.