Provider Demographics
NPI:1407421407
Name:SWINGLE, KYLEE DEVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:KYLEE
Middle Name:DEVIN
Last Name:SWINGLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KYLEE
Other - Middle Name:DEVIN
Other - Last Name:GIBEAUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9737 STONEBURNER RD NW
Mailing Address - Street 2:
Mailing Address - City:CROOKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43731-9647
Mailing Address - Country:US
Mailing Address - Phone:740-704-7011
Mailing Address - Fax:
Practice Address - Street 1:71 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MCCONNELSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43756-1180
Practice Address - Country:US
Practice Address - Phone:740-962-4281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006942152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist