MEDICARE: DR. KYLEE DEVIN SWINGLE OD

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
1	152W00000X	Optometrist	OPT.006942	OH

General Provider Information

NPI Number	:	1407421407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLEE DEVIN SWINGLE OD

Provider Business Mailing Address
First Line	:	9737 STONEBURNER RD NW
Second Line	:
City	:	CROOKSVILLE
State	:	OH
Zip	:	43731-9647
Country	:	US
Telephone Number	:	740-704-7011
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 E MAIN ST
Second Line	:
City	:	MCCONNELSVILLE
State	:	OH
Zip	:	43756-1180
Country	:	US
Telephone Number	:	740-962-4281
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2021
Last Update Date	:	05/21/2021

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