Healthcare Provider Details

I. General information

NPI: 1477906485
Provider Name (Legal Business Name): KIMBERLY SKYLES O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2016
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12377 137TH PL NE UNIT 130
REDMOND WA
98052-2232
US

IV. Provider business mailing address

12377 137TH PL NE UNIT 130
REDMOND WA
98052-2232
US

V. Phone/Fax

Practice location:
  • Phone: 425-885-3574
  • Fax:
Mailing address:
  • Phone: 425-885-3574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number60667876
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number60667876
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: