Individual
MACEY PRUETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
982 N TYLER RD STE A, WICHITA, KS 67212-3271
(316) 722-6452
(316) 722-6001
Mailing address
540 N DORIS ST, WICHITA, KS 67212-2431
(316) 680-5346
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2084
KS
Other
Enumeration date
07/14/2018
Last updated
07/14/2018
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