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NPI Code Detail

MEDICARE: KYLE BRENT DOTSON O.D.

MEDICARE: KYLE BRENT DOTSON O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1135-3KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15335OTHERKSBLUE CROSS

General Provider Information

NPI Number : 1174515985
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE BRENT DOTSON O.D.
Provider Business Mailing Address
First Line : 2211 SE 29TH ST
Second Line :
City : TOPEKA
State : KS
Zip : 66605-2461
Country : US
Telephone Number : 785-266-3240
Fax Number :
Provider Business Practice Location Address
First Line : 2211 SE 29TH ST
Second Line :
City : TOPEKA
State : KS
Zip : 66605-2461
Country : US
Telephone Number : 785-266-3240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2005
Last Update Date : 04/23/2008

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