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General NPI Number Information
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NPI Number | 1376729830
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Entity Type | Organization
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Legal Business Name | KYLE J. SCHELL, O.D., INC.
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 12370 HESPERIA RD # 11
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City | VICTORVILLE
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State | CA
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Zip | 92395-7719
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Country | US
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Telephone | 760-241-1010
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Fax | 769-024-1128
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Provider Business Mailing Address
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Address Line | 12370 HESPERIA RD STE 11
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City | VICTORVILLE
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State | CA
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Zip | 92395-4787
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Country | US
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Telephone | 760-241-1010
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Fax | 760-241-1281
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Authorized Official
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Title or Position | MANAGER
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Name | DIANA MARTINEZ
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Credential |
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Telephone | 760-241-1010
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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 | 8625T
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License Number State | CA
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