Organization
VISION SOURCE OF LIBERAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN D GRAHAM O.D. (DOCTOR)
(620) 624-3841
Entity
Organization
Contact information
Practice address
2136 N. KANSAS AVE, LIBERAL, KS 67901-2136
(620) 624-3841
(620) 624-0241
Mailing address
2136 N. KANSAS AVE, LIBERAL, KS 67901-2136
(620) 624-3841
(620) 624-0241
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1366-3
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
052571
MEDICARE PTAN
KS
01
—
1013931153
SOLE PROPRIETOR
KS
Enumeration date
10/04/2010
Last updated
08/19/2013
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