Provider Demographics
NPI:1164116281
Name:PHILLIPS, KAYLAN SAINATH (OD)
Entity Type:Individual
Prefix:DR
First Name:KAYLAN
Middle Name:SAINATH
Last Name:PHILLIPS
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 1:357 TUXFORD DRIVE
Mailing Address - Street 2:
Mailing Address - City:KAMLOOPS
Mailing Address - State:BC
Mailing Address - Zip Code:V2E 2M7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:617 SCOON RD
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-1031
Practice Address - Country:US
Practice Address - Phone:509-837-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD.61449723152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist