Individual
DR. CHAD T PREMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
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
1692
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200271240A
—
KS
01
—
P00189553
PALMENTTO GBA RR MEDICARE
KS
Enumeration date
01/31/2006
Last updated
05/06/2014
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