Organization
MAYDEW THIBAULT OPTOMETRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TROY O MAYDEW OD (MEMBER MANAGER)
(620) 886-3222
Entity
Organization
Contact information
Practice address
604 N WALNUT, MEDICINE LODGE, KS 67104
(620) 886-3222
(620) 886-3541
Mailing address
PO BOX 129, 604 N WALNUT, MEDICINE LODGE, KS 67104
(620) 886-3222
(620) 886-3541
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20051988B
—
KS
Enumeration date
01/23/2007
Last updated
05/07/2013
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