Individual
MINTA SUSAN TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2301 S WATER, WICHITA, KS 67213
(316) 425-7259
(316) 263-4116
Mailing address
2301 S WATER, WICHITA, KS 67213
(316) 425-7259
(316) 263-4116
Taxonomy
Speciality
Code
Description
License number
State
152WL0500X
Low Vision Rehabilitation Optometrist
Primary
ACVREP 2540
AZ
Other
Enumeration date
11/20/2006
Last updated
07/08/2007
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