MEDICARE: KAYLA SHAREE GADDIS 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
1	152W00000X	Optometrist	1541	LA
2	152W00000X	Optometrist	7132-T	TX

General Provider Information

NPI Number	:	1679764914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA SHAREE GADDIS O.D.

Provider Business Mailing Address
First Line	:	6851 VIRGINIA PKWY STE 101
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5622
Country	:	US
Telephone Number	:	214-865-6266
Fax Number	:	214-865-6305

Provider Business Practice Location Address
First Line	:	6851 VIRGINIA PKWY STE 101
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-5622
Country	:	US
Telephone Number	:	214-865-6266
Fax Number	:	214-865-6305

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

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	07/20/2013

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