Individual
DR. PHILLIP L. ERNZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
321 S HILLSIDE ST, WICHITA, KS 67211-2130
(316) 685-1898
Mailing address
8803 E CHURCHILL CIR, WICHITA, KS 67206-4441
(316) 636-4059
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
971-2
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10090610A
—
KS
Enumeration date
03/20/2006
Last updated
07/08/2007
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