Healthcare Provider Details

I. General information

NPI: 1679499842
Provider Name (Legal Business Name): KYLE J CALLAWAY OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2339 MEDICO LN STE 103
MELBOURNE FL
32940-8946
US

IV. Provider business mailing address

740 MUIRFIELD CIR
APOPKA FL
32712-2689
US

V. Phone/Fax

Practice location:
  • Phone: 321-344-0841
  • Fax:
Mailing address:
  • Phone: 816-262-1647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: KYLE CALLAWAY
Title or Position: OPTOMETRIST
Credential: OD
Phone: 816-262-1647