Provider Demographics
NPI:1881931954
Name:WINSLOW, KYLE EDWARD (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:KYLE
Middle Name:EDWARD
Last Name:WINSLOW
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 11TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-5021
Mailing Address - Country:US
Mailing Address - Phone:202-462-0055
Mailing Address - Fax:202-462-2837
Practice Address - Street 1:1802 11TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-5021
Practice Address - Country:US
Practice Address - Phone:202-462-0055
Practice Address - Fax:202-462-2837
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician