Provider Demographics
NPI:1063769438
Name:WAINWRIGHT, KYLE (OD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:WAINWRIGHT
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 1:101 BLUEMONT AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5093
Mailing Address - Country:US
Mailing Address - Phone:785-539-8019
Mailing Address - Fax:785-587-0676
Practice Address - Street 1:101 BLUEMONT AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-5093
Practice Address - Country:US
Practice Address - Phone:785-539-8019
Practice Address - Fax:785-587-0676
Is Sole Proprietor?:No
Enumeration Date:2012-08-04
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist