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General NPI Number Information
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NPI Number | 1124883012
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Entity Type | Individual
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Provider Name | KYLE CRISWELL OD
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Gender | Male
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 08/24/2025
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Provider Practice Location Address
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Address Line | 8801 N INDIAN TRAIL RD STE I
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City | SPOKANE
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State | WA
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Zip | 99208-6058
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Country | US
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Telephone | 509-868-0215
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Fax |
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Provider Business Mailing Address
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Address Line | 8801 N INDIAN TRAIL RD STE 1
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City | SPOKANE
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State | WA
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Zip | 99208-6052
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Country | US
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Telephone | 509-868-0215
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Fax | 509-868-0245
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 35753
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD61568824
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License Number State | WA
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