Provider Demographics
NPI:1316252455
Name:OSMOTHERLY, KAILA MICHELLE (OD)
Entity type:Individual
Prefix:DR
First Name:KAILA
Middle Name:MICHELLE
Last Name:OSMOTHERLY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5865 W UTOPIA RD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5251
Mailing Address - Country:US
Mailing Address - Phone:623-537-6000
Mailing Address - Fax:623-806-7210
Practice Address - Street 1:5865 W UTOPIA RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5251
Practice Address - Country:US
Practice Address - Phone:623-537-6000
Practice Address - Fax:623-806-7210
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2680152W00000X
AZ1805152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist