Provider Demographics
NPI:1467104828
Name:DEGMAN, KYLE JOSEPH (OD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:JOSEPH
Last Name:DEGMAN
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 1:1750 SW 139TH AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1062
Mailing Address - Country:US
Mailing Address - Phone:503-730-6922
Mailing Address - Fax:
Practice Address - Street 1:3460 TEN TEN RD STE 112B
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6303
Practice Address - Country:US
Practice Address - Phone:919-367-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2779152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty