Provider Demographics
NPI:1972778009
Name:KYLE SEXTON, O.D., LLC
Entity Type:Organization
Organization Name:KYLE SEXTON, O.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-864-9353
Mailing Address - Street 1:3500 S MERIDIAN
Mailing Address - Street 2:SPACE 945
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3779
Mailing Address - Country:US
Mailing Address - Phone:253-864-9353
Mailing Address - Fax:253-864-9355
Practice Address - Street 1:3500 S MERIDIAN
Practice Address - Street 2:SPACE 945
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3779
Practice Address - Country:US
Practice Address - Phone:253-864-9353
Practice Address - Fax:253-864-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty