Organization
MARK BETTENCOURT, O.D. PC
Active
Other names
Vision Source
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA J WARREN (OFFICE MANAGER)
(785) 456-8900
Entity
Organization
Contact information
Practice address
1405 W US HIGHWAY 24, WAMEGO, KS 66547-1256
(785) 456-8900
(785) 456-8902
Mailing address
1405 W US HIGHWAY 24, WAMEGO, KS 66547-1256
(785) 456-8900
(785) 456-8902
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1234-2
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0692920001
DMERC
KS
01
—
410014173
RAILROAD MEDICARE
KS
01
—
650563
BCBS
KS
Enumeration date
09/08/2005
Last updated
12/14/2011
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