Provider Demographics
NPI:1841670650
Name:CAPEL, KYLE (OD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:CAPEL
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 1:921 PENLLYN BLUE BELL PIKE
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-2163
Mailing Address - Country:US
Mailing Address - Phone:215-628-2020
Mailing Address - Fax:215-628-3131
Practice Address - Street 1:921 PENLLYN BLUE BELL PIKE
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2163
Practice Address - Country:US
Practice Address - Phone:156-282-0202
Practice Address - Fax:215-628-3131
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2019-05-02
Deactivation Date:2018-08-23
Deactivation Code:
Reactivation Date:2018-09-17
Provider Licenses
StateLicense IDTaxonomies
PAOEG003030152WL0500X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics