Provider Demographics
NPI:1629546668
Name:KOUBEK, KYLE (OD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:KOUBEK
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 1:26927 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2370
Mailing Address - Country:US
Mailing Address - Phone:440-892-5367
Mailing Address - Fax:
Practice Address - Street 1:26927 DETROIT RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2370
Practice Address - Country:US
Practice Address - Phone:440-892-5367
Practice Address - Fax:440-249-5094
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006701152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist