Paul E Bullock, O.D.
Individual provider Active NPI Optometrist · Manhattan, KS
NPI 1164517611 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1164517611
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 912-3 (KS)
- Practice address
- 1441 Anderson Avenue
Manhattan, KS 66502-4072 - Phone
- (785) 776-9461
- Fax
- (785) 776-9946
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 9121 | KS | MD | Clinical Social Worker |
| 912-3 | KS | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye Care Associates of Manhattan, P.a. | Optometrist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 912-3 | KS | Yes |
Addresses
Primary practice location
1441 Anderson Avenue
Manhattan, KS 66502-4072
Mailing address
1441 Anderson Avenue
Manhattan, KS 66502-4072
Phone (785) 776-9461
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 912-3 | Other | KS | STATE LICENSE NUMBER |
Other providers in Manhattan, 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.