Provider Demographics
NPI:1578545869
Name:ABSHIRE, KYLE D (OD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:D
Last Name:ABSHIRE
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 1:960 PLAINFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-3949
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:905 PARK AVE
Practice Address - Street 2:STE 100
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4101
Practice Address - Country:US
Practice Address - Phone:904-264-1206
Practice Address - Fax:904-264-3685
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 809152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4410864OtherAETNA
FL20207OtherBLUE CROSS BLUE SHIELD FL
FL2203741OtherUNITED HEALTHCARE
FL4410864OtherAETNA
FLT83979Medicare UPIN
FL20207ZMedicare PIN