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MAYDEW THIBAULT OPTOMETRY LLC NPI 1356638662


NPI Information

NPI: 1356638662
Provider Name: MAYDEW THIBAULT OPTOMETRY LLC

Other Name: KINGMAN EYE CARE

Classification: Optometrist - 152W00000X
Entity Type: Organization

CLIA Number: 17D2215236

Address:
104 WEST C AVE
KINGMAN, KS
ZIP 67068
Phone: (620) 532-3154
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MAYDEW THIBAULT OPTOMETRY LLC is an optometrist in Kingman, KS. The provider is doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. MAYDEW THIBAULT OPTOMETRY LLC NPI is 1356638662. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Other Name Is Kingman Eye Care.

The provider's business location address is:

104 WEST C AVE
KINGMAN, KS
ZIP 67068-313
Phone: (620) 532-3154
Fax: (620) 532-5662

The provider's authorized official is Seth A Thibault .
The authorized official title is Dr and has the following contact phone number (620) 672-5934.

The CLIA number assigned to this NPI record is 17D2215236 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/7/2011 and was last updated on 8/1/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1152W00000XOptometrist1017-3KANSASNo
2152W00000XOptometrist1696KANSASYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1200732580AMEDICAIDKANSAS
21306600003MEDICARE NSCKANSAS
3650512MEDICARE PINKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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