Individual
JAMES R PACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1039 N BROADWAY ST, WICHITA, KS 67214-2906
(316) 262-8476
(316) 262-8477
Mailing address
1039 N BROADWAY ST, WICHITA, KS 67214-2906
(316) 262-8476
(316) 262-8477
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
972-3
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100090590B
—
KS
01
—
1241
PREFERRED HEALTH SYSTEMS
KS
01
—
4083937
AETNA
KS
01
—
410044812
RAILROAD MEDICARE
KS
01
—
650799
BLUE CROSS BLUE SHIELD
KS
01
—
665030
FIRST GUARD
KS
Enumeration date
08/31/2005
Last updated
06/14/2011
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