Provider Demographics
NPI:1215248778
Name:HUGHES, KYLE BRYAN (OD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:BRYAN
Last Name:HUGHES
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 1:8850 W 58TH AVE
Mailing Address - Street 2:#100
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-2252
Mailing Address - Country:US
Mailing Address - Phone:303-421-8990
Mailing Address - Fax:303-421-9402
Practice Address - Street 1:8850 W 58TH AVE
Practice Address - Street 2:#100
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2252
Practice Address - Country:US
Practice Address - Phone:303-421-8990
Practice Address - Fax:303-421-9402
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV673152W00000X
CO2895152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV37415Medicare PIN