Individual
DR. HENRY LEE BUMGARDNER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2205 S SENECA ST, WICHITA, KS 67213-4224
(316) 264-9131
(316) 264-4649
Mailing address
2205 S SENECA ST, WICHITA, KS 67213-4224
(316) 264-9131
(316) 264-4649
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
997-3
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005262
BLUE CROSS BLUE SHIELD
KS
01
—
130
PREFERRED PLUS KANSAS
KS
01
—
3239530
CIGNA
KS
01
—
333128
COVENTRY
KS
01
—
480801828
FEDERAL IDENTIFICATION #
KS
01
—
997-3
KANSAS OPTOMETRY LICENSE
KS
Enumeration date
08/31/2006
Last updated
10/12/2008
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