Provider Demographics
NPI:1922839828
Name:NIELAND, KYLE (OD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:NIELAND
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 1:1301 E NORTHLAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-8582
Mailing Address - Country:US
Mailing Address - Phone:920-734-8714
Mailing Address - Fax:920-734-8785
Practice Address - Street 1:1301 E NORTHLAND AVE STE A
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-8582
Practice Address - Country:US
Practice Address - Phone:920-734-8714
Practice Address - Fax:920-734-8785
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4025-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist