Provider Demographics
NPI:1649756016
Name:MCCARTHY, KYLE R (OD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:R
Last Name:MCCARTHY
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 1:82 CALLE ESCALON
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1709
Mailing Address - Country:US
Mailing Address - Phone:805-469-5210
Mailing Address - Fax:
Practice Address - Street 1:99 E DAILY DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5823
Practice Address - Country:US
Practice Address - Phone:805-482-8849
Practice Address - Fax:805-388-8516
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATLG34000152W00000X
390200000X
CAOPT34000-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program