Provider Demographics
NPI:1366167033
Name:BEYERLE, KIPP DEVINE (OD)
Entity type:Individual
Prefix:DR
First Name:KIPP
Middle Name:DEVINE
Last Name:BEYERLE
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 1:2255 CAPE PINE WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3882
Mailing Address - Country:US
Mailing Address - Phone:702-533-3571
Mailing Address - Fax:
Practice Address - Street 1:2255 CAPE PINE WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3882
Practice Address - Country:US
Practice Address - Phone:702-533-3571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003847152W00000X
WA61360316152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist