Provider Demographics
NPI:1700634979
Name:MCCAIG, KAYLA (OD)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:MCCAIG
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 1:4669 155TH AVE
Mailing Address - Street 2:
Mailing Address - City:HERSEY
Mailing Address - State:MI
Mailing Address - Zip Code:49639-8761
Mailing Address - Country:US
Mailing Address - Phone:616-335-0145
Mailing Address - Fax:
Practice Address - Street 1:1775 S MITCHELL ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8533
Practice Address - Country:US
Practice Address - Phone:231-775-1248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005800APP24152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist