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General NPI Number Information
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NPI Number | 1568568384
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Entity Type | Individual
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Provider Name | KYLE M CHEATHAM O. D.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 2514 W BROADWAY
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51501-3509
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Country | US
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Telephone | 712-322-3097
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Fax | 712-322-4130
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Provider Business Mailing Address
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Address Line | 2514 W BROADWAY
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51501-3509
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Country | US
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Telephone | 711-322-3097
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Fax | 712-322-4130
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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 | 1267
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License Number State | NE
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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 | 02373
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License Number State | IA
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