Provider Demographics
NPI:1083707384
Name:MCKYTON, RICHARD ALEXANDER (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALEXANDER
Last Name:MCKYTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 VANDERBILT BEACH RD.
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108
Mailing Address - Country:US
Mailing Address - Phone:239-598-1332
Mailing Address - Fax:239-598-1332
Practice Address - Street 1:821 VANDERBILT BEACH RD.
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108
Practice Address - Country:US
Practice Address - Phone:239-598-1332
Practice Address - Fax:239-598-1332
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL001547152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0531320001OtherMDICARE SUPPLIER #
FLT84148Medicare UPIN
FL19700Medicare ID - Type UnspecifiedMEDICARE ID