Organization
MCCAULLEY OPTOMETRIC PA
Active
Other names
The 10th Street Eyecare Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL L MCCAULLEY O.D. (OWNER)
(620) 792-2020
Entity
Organization
Contact information
Practice address
2601 10TH ST, GREAT BEND, KS 67530-4253
(620) 792-2020
(620) 792-2583
Mailing address
2601 10TH ST, GREAT BEND, KS 67530-4253
(620) 792-2020
(620) 792-2583
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1198-3
KS
152W00000X
Optometrist
1692
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005344
BCBS GROUP NUMBER
KS
01
—
020075001
CIGNA MC GROUP NUMBER
KS
05
—
100213630A
—
KS
Enumeration date
06/19/2006
Last updated
06/23/2008
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