Provider Demographics
NPI:1205090990
Name:KLIKA, KYLE J (OD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:J
Last Name:KLIKA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:W3208 VAN ROY RD.
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915
Mailing Address - Country:US
Mailing Address - Phone:920-733-3846
Mailing Address - Fax:920-733-3964
Practice Address - Street 1:700 PILGRIM WAY
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5263
Practice Address - Country:US
Practice Address - Phone:920-733-3846
Practice Address - Fax:920-733-3964
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3111152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist