Healthcare Provider Details

I. General information

NPI: 1649756016
Provider Name (Legal Business Name): KYLE R MCCARTHY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 08/05/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 E DAILY DR
CAMARILLO CA
93010-5823
US

IV. Provider business mailing address

82 CALLE ESCALON
CAMARILLO CA
93010-1709
US

V. Phone/Fax

Practice location:
  • Phone: 805-482-8849
  • Fax: 805-388-8516
Mailing address:
  • Phone: 805-469-5210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTLG34000
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT34000-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: