Healthcare Provider Details

I. General information

NPI: 1265915961
Provider Name (Legal Business Name): KALLIE ANN KAPPES O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6360 MAE ANNE AVE STE 1
RENO NV
89523-4719
US

IV. Provider business mailing address

6360 MAE ANNE AVE STE 1
RENO NV
89523-4719
US

V. Phone/Fax

Practice location:
  • Phone: 775-787-9137
  • Fax: 775-323-3652
Mailing address:
  • Phone: 775-787-9137
  • Fax: 775-323-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number973
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: