Organization
SOUTHEAST KANSAS EYE CARE ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARRICK A RETTELE M.D. (PRESIDENT)
(620) 251-3235
Entity
Organization
Contact information
Practice address
1411 W 4TH ST, SUITE D, COFFEYVILLE, KS 67337-3300
(620) 251-3235
(620) 251-3252
Mailing address
1411 W 4TH ST, SUITE D, COFFEYVILLE, KS 67337-3300
(620) 251-3235
(620) 251-3252
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003804
BCBS PROVIDER NUMBER
KS
Enumeration date
03/03/2006
Last updated
06/12/2008
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