Healthcare Provider Details

I. General information

NPI: 1407421407
Provider Name (Legal Business Name): KYLEE DEVIN SWINGLE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLEE DEVIN GIBEAUT

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 E MAIN ST
MCCONNELSVILLE OH
43756-1180
US

IV. Provider business mailing address

9737 STONEBURNER RD NW
CROOKSVILLE OH
43731-9647
US

V. Phone/Fax

Practice location:
  • Phone: 740-962-4281
  • Fax:
Mailing address:
  • Phone: 740-704-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.006942
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: