Vision Source of Liberal Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

1366-3 Issued in KS

Legal business name

VISION SOURCE OF LIBERAL INC

Practice address

2136 N. Kansas Ave
Liberal, KS 67901-2136

Phone

(620) 624-3841

Fax

(620) 624-0241

NPI assigned

Oct 4, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Steven D Graham, O.D.

Title

Doctor

Phone

(620) 624-3841

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376870400000",
    "number": "1447569892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2136 N. KANSAS AVE",
            "city": "LIBERAL",
            "state": "KS",
            "postal_code": "679012136",
            "telephone_number": "620-624-3841",
            "fax_number": "620-624-0241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2136 N. KANSAS AVE",
            "city": "LIBERAL",
            "state": "KS",
            "postal_code": "679012136",
            "telephone_number": "620-624-3841",
            "fax_number": "620-624-0241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISION SOURCE OF LIBERAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-04",
        "last_updated": "2013-08-19",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "620-624-3841",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "KS",
            "license": "1366-3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "052571",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOLE PROPRIETOR",
            "identifier": "1013931153",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Liberal, KS
• Optometrist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.