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Individual

KATILYN C BROBERG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OD

Contact information

Practice address
2635 W DOUGLAS AVE, WICHITA, KS 67213-2605
(316) 942-7496
Mailing address
1652 S BUTTERNUT ST, WICHITA, KS 67230-7633
(316) 305-2750

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2168
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
48-1046124
KS
Enumeration date
08/01/2022
Last updated
08/01/2022
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