Provider Demographics
NPI:1124638606
Name:POPP, KYLER JAMES (OD)
Entity type:Individual
Prefix:
First Name:KYLER
Middle Name:JAMES
Last Name:POPP
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 1:42550 GARFIELD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1644
Mailing Address - Country:US
Mailing Address - Phone:586-263-9708
Mailing Address - Fax:
Practice Address - Street 1:42550 GARFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1644
Practice Address - Country:US
Practice Address - Phone:586-263-9708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-09
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901005464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty