Organization
MAYDEW THIBAULT OPTOMETRY LLC
Active
Other names
Kingman Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SETH A THIBAULT O.D. (DR)
(620) 672-5934
Entity
Organization
Contact information
Practice address
104 WEST C AVE, KINGMAN, KS 67068-1313
(620) 532-3154
(620) 532-5662
Mailing address
104 WEST C AVE, KINGMAN, KS 67068-1313
(620) 532-3154
(620) 532-5662
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1017-3
KS
152W00000X
Optometrist
Primary
1696
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200732580A
—
KS
Enumeration date
07/07/2011
Last updated
08/01/2012
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