Healthcare Provider Details

I. General information

NPI: 1083707384
Provider Name (Legal Business Name): RICHARD ALEXANDER MCKYTON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 VANDERBILT BEACH RD.
NAPLES FL
34108
US

IV. Provider business mailing address

821 VANDERBILT BEACH RD.
NAPLES FL
34108
US

V. Phone/Fax

Practice location:
  • Phone: 239-598-1332
  • Fax: 239-598-1332
Mailing address:
  • Phone: 239-598-1332
  • Fax: 239-598-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number001547
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: