Individual
DR. RUSSELL L DOERKSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
7570 W 21ST ST N, BLDG 1002, WICHITA, KS 67205-1734
(316) 721-3377
(316) 721-6077
Mailing address
7570 W 21ST ST N, BLDG 1002, WICHITA, KS 67205-1734
(316) 721-3377
(316) 721-6077
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1324
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
049837
BLUE CROSS/BLUE SHIELD
KS
01
—
3712
PREFERRED HEALTH SYSTEM
KS
Enumeration date
09/20/2006
Last updated
06/10/2015
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