Organization
JAMES R. PACE, O.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES REX PACE O.D. (PROPRIATOR)
(316) 262-8476
Entity
Organization
Contact information
Practice address
1039 N BROADWAY ST, WICHITA, KS 67214-2906
(316) 262-8476
(316) 262-8477
Mailing address
1039 N BROADWAY ST, WICHITA, KS 67214-2906
(316) 262-8476
(316) 262-8477
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
972-3
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100090590B
—
KS
01
—
4083937
AETNA
KS
01
—
410044812
RAILROAD MEDICARE
KS
01
—
63197
MISSOURI PACIFIC TRAVELER
KS
01
—
650799
BLUECROSS BLUE SHIELD
KS
Enumeration date
03/28/2008
Last updated
09/30/2011
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