Provider Demographics
NPI:1790193431
Name:DYKE, KATHLEEN HAWLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:HAWLEY
Last Name:DYKE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:BYRNE
Other - Last Name:HAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:827 DEEP VALLEY DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3647
Mailing Address - Country:US
Mailing Address - Phone:310-541-3411
Mailing Address - Fax:
Practice Address - Street 1:827 DEEP VALLEY DR
Practice Address - Street 2:SUITE 311
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3647
Practice Address - Country:US
Practice Address - Phone:310-541-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15033152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy