Healthcare Provider Details

I. General information

NPI: 1790193431
Provider Name (Legal Business Name): KATHLEEN HAWLEY DYKE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN BYRNE HAWLEY O.D.

II. Dates (important events)

Enumeration Date: 07/25/2014
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 DEEP VALLEY DR SUITE 311
ROLLING HILLS ESTATES CA
90274-3647
US

IV. Provider business mailing address

827 DEEP VALLEY DR SUITE 311
ROLLING HILLS ESTATES CA
90274-3647
US

V. Phone/Fax

Practice location:
  • Phone: 310-541-3411
  • Fax:
Mailing address:
  • Phone: 310-541-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number15033
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number15033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: