Provider Demographics
NPI:1477074938
Name:THAXTON, KYLE RAY (OD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:RAY
Last Name:THAXTON
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 1:4342 TREANOR DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-7012
Mailing Address - Country:US
Mailing Address - Phone:325-673-0900
Mailing Address - Fax:
Practice Address - Street 1:4342 TREANOR DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-7012
Practice Address - Country:US
Practice Address - Phone:325-673-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9296T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist