Provider Demographics
NPI:1609880517
Name:BECHTOLD, KYLE ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ROBERT
Last Name:BECHTOLD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2800 SW WANAMAKER RD
Mailing Address - Street 2:SUITE 192
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4293
Mailing Address - Country:US
Mailing Address - Phone:785-272-0707
Mailing Address - Fax:785-271-1512
Practice Address - Street 1:2720 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-4571
Practice Address - Country:US
Practice Address - Phone:913-651-3344
Practice Address - Fax:913-651-1029
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1734152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200389060AMedicaid
KS651208OtherBCBS
KS200389060DMedicaid
651115OtherBCBS
39001011OtherBCBS OF KANSAS CITY
KS200389060AMedicaid
651136Medicare PIN