Provider Demographics
NPI:1821289778
Name:ECKHART, KYLE F (CPO)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:F
Last Name:ECKHART
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 WEBSTER ST
Mailing Address - Street 2:STE. E
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4997
Mailing Address - Country:US
Mailing Address - Phone:707-425-5028
Mailing Address - Fax:
Practice Address - Street 1:1525 WEBSTER ST
Practice Address - Street 2:STE. E
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4997
Practice Address - Country:US
Practice Address - Phone:707-425-5028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5887210001Medicare NSC