Provider Demographics
NPI:1740696897
Name:TETRAULT, KYLE FRANKLIN (OD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:FRANKLIN
Last Name:TETRAULT
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:13772 DENVER WEST PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3139
Mailing Address - Country:US
Mailing Address - Phone:303-279-6600
Mailing Address - Fax:303-279-9140
Practice Address - Street 1:13772 DENVER WEST PKWY STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3139
Practice Address - Country:US
Practice Address - Phone:303-279-6600
Practice Address - Fax:303-279-9140
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2001152W00000X
CO3111152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist