Healthcare Provider Details

I. General information

NPI: 1881931954
Provider Name (Legal Business Name): KYLE EDWARD WINSLOW OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 11TH ST NW
WASHINGTON DC
20001-5021
US

IV. Provider business mailing address

1802 11TH ST NW
WASHINGTON DC
20001-5021
US

V. Phone/Fax

Practice location:
  • Phone: 202-462-0055
  • Fax: 202-462-2837
Mailing address:
  • Phone: 202-462-0055
  • Fax: 202-462-2837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: