Kyle Gwinner OD LLC
Organization Active NPI Optometrist · Ellsworth, KS
NPI 1609918523 · NPPES record last updated Sep 4, 2014
Key facts
- NPI
- 1609918523
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- KYLE GWINNER OD LLC
- Practice address
- 801 E 3Rd St
Ellsworth, KS 67439-0339 - Phone
- (785) 472-3272
- Fax
- (785) 472-3360
- NPI assigned
- Feb 14, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. G. Kyle Gwinner, O.D.
- Title
- Optometrist
- Phone
- (785) 472-3272
Practitioners 1
-
Grant K Gwinner, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070423000052 | KS | Part B Supplier - Clinic/Group Practice | 6507961497 |
Receives reassigned benefits from 1 practitioner Practice locations: Lincoln, KS; Ellsworth, KS |
| O20100930084474 | KS | DME Supplier - Physician - Optometrist | 6507961497 | Practice locations: Ellsworth, KS |
National Provider Directory
Locations
801 E 3rd St
Ste A
Ellsworth, KS 67439
Phone (785) 472-3272
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
801 E 3Rd St
Ellsworth, KS 67439-0339
Mailing address
PO Box 339
Ellsworth, KS 67439-0339
Phone (785) 472-3272
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100090550D | 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 Sep 4, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.