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General NPI Number Information
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NPI Number | 1972778009
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Entity Type | Organization
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Legal Business Name | KYLE SEXTON, O.D., LLC
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 3500 S MERIDIAN SPACE 945
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City | PUYALLUP
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State | WA
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Zip | 98373-3779
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Country | US
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Telephone | 253-864-9353
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Fax | 253-864-9355
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Provider Business Mailing Address
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Address Line | 3500 S MERIDIAN SPACE 945
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City | PUYALLUP
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State | WA
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Zip | 98373-3779
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Country | US
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Telephone | 253-864-9353
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Fax | 253-864-9355
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Authorized Official
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Title or Position | OWNER
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Name | DR. KYLE SEXTON
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Credential | O.D.
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Telephone | 253-864-9353
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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 |
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License Number State |
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