Organization
IOLA VISION SOURCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS A DONNELLY OD (MEMBER)
(620) 365-2108
Entity
Organization
Contact information
Practice address
216 N JEFFERSON AVE, IOLA, KS 66749-2943
(620) 365-2108
(620) 365-2108
Mailing address
PO BOX 847, IOLA, KS 66749-0847
(620) 365-2108
(620) 365-2522
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100642380A
—
KS
01
—
DA4480
RAILROAD MEDICARE #
KS
Enumeration date
10/11/2006
Last updated
07/21/2022
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