Provider Demographics
NPI:1265915961
Name:KAPPES, KALLIE ANN (OD)
Entity type:Individual
Prefix:
First Name:KALLIE
Middle Name:ANN
Last Name:KAPPES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3118 STERLING RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-4390
Mailing Address - Country:US
Mailing Address - Phone:775-340-2549
Mailing Address - Fax:
Practice Address - Street 1:2285 GREEN VISTA DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-1071
Practice Address - Country:US
Practice Address - Phone:775-674-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV973152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty