Provider Demographics
NPI:1669600136
Name:WEEDEN, KYLE A (OD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:A
Last Name:WEEDEN
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 1:247 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2331
Mailing Address - Country:US
Mailing Address - Phone:816-434-5858
Mailing Address - Fax:816-434-5845
Practice Address - Street 1:2008 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-3340
Practice Address - Country:US
Practice Address - Phone:785-354-8383
Practice Address - Fax:785-354-8386
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS1830152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00796972OtherRAILROAD MEDICARE
KSDF9773OtherGROUP RAILROAD MEDICARE NUMBER
KS1124043021OtherGROUP NPI NUMBER
KS650522002Medicare PIN