Basic Information
| Provider Information | |||||||||
| NPI: | 1215248778 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUGHES | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | BRYAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8850 W 58TH AVE | ||||||||
| Address2: | #100 | ||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800022252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034218990 | ||||||||
| FaxNumber: | 3034219402 | ||||||||
| Practice Location | |||||||||
| Address1: | 8850 W 58TH AVE | ||||||||
| Address2: | #100 | ||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800022252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034218990 | ||||||||
| FaxNumber: | 3034219402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2010 | ||||||||
| LastUpdateDate: | 01/22/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 673 | NV | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 2895 | CO | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.