Provider Demographics
NPI:1184395816
Name:CARNAHAN, KYLE BRADLEY (OD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:BRADLEY
Last Name:CARNAHAN
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:PO BOX 773
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-0773
Mailing Address - Country:US
Mailing Address - Phone:641-752-1511
Mailing Address - Fax:641-753-8773
Practice Address - Street 1:501 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-1906
Practice Address - Country:US
Practice Address - Phone:641-752-1511
Practice Address - Fax:641-753-8773
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA108269152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist