Provider Demographics
NPI:1932385986
Name:RIPPEL, KYLE W (OD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:W
Last Name:RIPPEL
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 1:2879 W 95TH ST
Mailing Address - Street 2:SUITE 179
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9007
Mailing Address - Country:US
Mailing Address - Phone:630-922-8000
Mailing Address - Fax:630-922-7754
Practice Address - Street 1:2879 W 95TH ST
Practice Address - Street 2:SUITE 179
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9007
Practice Address - Country:US
Practice Address - Phone:630-922-8000
Practice Address - Fax:630-922-7754
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-20
Last Update Date:2008-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU60847Medicare UPIN
IL203933Medicare PIN