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Organization

ROD D STOY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MITZI M BRYANT (INSURANCE SPECIALIST)
(620) 442-2577
Entity
Organization

Contact information

Practice address
2508 EDGEMONT DR, SUITE #6, ARKANSAS CITY, KS 67005-3844
(620) 442-2577
(620) 442-2578
Mailing address
2508 EDGEMONT DR, SUITE #6, ARKANSAS CITY, KS 67005-3844
(620) 442-2577
(620) 442-2578

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1052-2
KS
152W00000X
Optometrist
1600
KS
152W00000X
Optometrist
1739
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
065070
BLUE CROSS BLUE SHIELD
KS
Enumeration date
01/26/2006
Last updated
08/22/2020
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