Garrick A Rettele, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

04-26308 Issued in KS

Practice address

1411 W 4TH St
Ste D
Coffeyville, KS 67337-3300

Phone

(620) 251-3235

Fax

(620) 251-3252

NPI assigned

Jun 23, 2005

Last updated

Feb 11, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southeast Kansas Eye Care Associates, P.a.

  • Ophthalmology Physician
  • Coffeyville, KS
  • NPI 1144297581
  Authorized official Same address or phone

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

{
    "created_epoch": "1119484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202688000000",
    "number": "1801892898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 W 4TH ST",
            "address_2": "STE D",
            "city": "COFFEYVILLE",
            "state": "KS",
            "postal_code": "673373300",
            "telephone_number": "620-251-3235",
            "fax_number": "620-251-3252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 W 4TH ST",
            "address_2": "STE D",
            "city": "COFFEYVILLE",
            "state": "KS",
            "postal_code": "673373300",
            "telephone_number": "620-251-3235",
            "fax_number": "620-251-3252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RETTELE",
        "first_name": "GARRICK",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-23",
        "last_updated": "2008-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "KS",
            "license": "04-26308",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF KS",
            "identifier": "041849",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100190920A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenda Louise Pursley, RPA-C
• Rauch Med-Econ Pharmacy, Inc
• Stephen Kent Rauch, R.PH.
• Raymond G Hawley MD PA
• Rebecca Dobbins, O.D., P.a.
• Jeffrey Wayne Rivers, PHARM.D.
• RJT Enterprises Inc. (Comforting Angels)
• Russell E Robson
• Saint-Mark Enterprises #1153 LLC (The Medicine Shoppe Pharmacy)
• Geeta Sandhu, M.D.

• Ophthalmology Physician in Coffeyville, KS
• Providers in Coffeyville, KS by specialty
• Ophthalmology Physician in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.