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General NPI Number Information
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NPI Number | 1326492190
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Entity Type | Organization
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Legal Business Name | KYLER KNOBBE, OD, LLC
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Dates
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Enumeration Date | 04/19/2016
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 1405 W US HIGHWAY 24
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City | WAMEGO
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State | KS
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Zip | 66547-1256
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Country | US
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Telephone | 785-456-8900
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Fax | 785-456-8902
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Provider Business Mailing Address
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Address Line | 1405 W US HIGHWAY 24
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City | WAMEGO
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State | KS
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Zip | 66547-1256
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Country | US
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Telephone | 785-456-8900
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Fax | 785-456-8902
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Authorized Official
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Title or Position | OPTOMETRIST/SOLE OWNER
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Name | KYLER KNOBBE
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Credential | O.D.
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Telephone | 785-456-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 2008
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License Number State | KS
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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 | 2008
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License Number State | KS
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