Organization
G DERRIL GWINNER, O.D. L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. G. DERRIL GWINNER O.D. (OPTOMETRIST)
(785) 472-3272
Entity
Organization
Contact information
Practice address
208 W LINCOLN AVE, LINCOLN, KS 67455-1920
(785) 524-5244
Mailing address
PO BOX 268, LINCOLN, KS 67455-0268
(785) 524-5244
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
9613
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017277
MEDICARE ID - TYPE UNSPECIFIED
KS
05
—
100090550B
—
KS
Enumeration date
04/06/2009
Last updated
04/06/2009
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