Provider Demographics
NPI:1770013641
Name:MARR, KYLE D (OD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:D
Last Name:MARR
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 1:10036 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66220-3802
Mailing Address - Country:US
Mailing Address - Phone:913-707-9009
Mailing Address - Fax:
Practice Address - Street 1:10036 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66220-3802
Practice Address - Country:US
Practice Address - Phone:913-254-7456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2059152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist