Provider Demographics
NPI:1053387589
Name:ASSOCIATED EYE SURGICAL CENTER INC
Entity type:Organization
Organization Name:ASSOCIATED EYE SURGICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:KINGREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-263-6273
Mailing Address - Street 1:1100 N TOPEKA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2810
Mailing Address - Country:US
Mailing Address - Phone:316-263-6273
Mailing Address - Fax:316-263-5568
Practice Address - Street 1:1100 N TOPEKA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2810
Practice Address - Country:US
Practice Address - Phone:316-263-6273
Practice Address - Fax:316-263-5568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSS087002261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100217370AMedicaid
KS119915Medicare ID - Type Unspecified