Organization
HARLEY'S CYCLE SUPPLY
Active
Other names
A & B Optical
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANGELA LEIGH UPDEGRAFF ABOC (MANAGER)
(620) 663-4411
Entity
Organization
Contact information
Practice address
1500 EAST 11TH AVE, HUTCHINSON, KS 67502
(620) 663-4411
Mailing address
1500 E 11TH AVE, HUTCHINSON, KS 67501-3701
(620) 663-4411
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
151179
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117550
BLUECROSSBLUESHIELD OF KS
KS
Enumeration date
09/06/2006
Last updated
08/22/2020
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