Provider Demographics
NPI:1720137284
Name:KYLE, DAVID ALA (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALA
Last Name:KYLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1055 W BARAGA AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4068
Practice Address - Country:US
Practice Address - Phone:906-228-8808
Practice Address - Fax:906-228-9022
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2023-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4901003683152WC0802X, 152WP0200X, 152WS0006X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95OE265210OtherBLUECROSSBLUESHIELD
MI94-3319568Medicaid
MI383326048OtherEINNUMBER
MIMO34439OtherTRICARE