Individual
MR. JIMMY LEE POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1411 W 4TH ST, COFFEYVILLE, KS 67337-3300
(620) 251-0050
(620) 251-0050
Mailing address
1411 W 4TH ST, COFFEYVILLE, KS 67337-3300
(620) 251-0050
(620) 251-0050
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100095230A
—
KS
01
—
OP7674
BLUE CROSS & BLUE SHIELD
KS
Enumeration date
03/09/2006
Last updated
02/25/2015
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