Provider Demographics
NPI:1669684072
Name:LUO, CAESAR KYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAESAR
Middle Name:KYLE
Last Name:LUO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 LENNON LN STE 250
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5915
Mailing Address - Country:US
Mailing Address - Phone:925-943-6800
Mailing Address - Fax:925-943-6880
Practice Address - Street 1:365 LENNON LN STE 250
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-5915
Practice Address - Country:US
Practice Address - Phone:925-943-6800
Practice Address - Fax:925-943-6880
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148441207W00000X
CAC148441207WX0107X, 207WX0107X
PAMD445862207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20-0300649OtherGROUP TAX ID #
PA102728271Medicaid
PA1205878915OtherGROUP NPI
PA1861435174OtherGROUP NPI
PA23-2413259OtherGROUP TAX ID
PA102728271Medicaid
PA242838KHMMedicare PIN
PA20-0300649OtherGROUP TAX ID #