Provider Demographics
NPI:1619969649
Name:HOSKINS, KYLE FREDERICK (OD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:FREDERICK
Last Name:HOSKINS
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 1:17900 IRELAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-3050
Mailing Address - Country:US
Mailing Address - Phone:574-291-9280
Mailing Address - Fax:574-299-1163
Practice Address - Street 1:17900 IRELAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-3050
Practice Address - Country:US
Practice Address - Phone:574-291-9280
Practice Address - Fax:574-299-1163
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002697152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0912650001Medicare NSC
INM400025040Medicare PIN
INU51413Medicare UPIN