Provider Demographics
NPI:1427464890
Name:POLHAMUS, KYLENE ANN (OD)
Entity type:Individual
Prefix:
First Name:KYLENE
Middle Name:ANN
Last Name:POLHAMUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 CITY CENTER DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3104
Mailing Address - Country:US
Mailing Address - Phone:317-846-4223
Mailing Address - Fax:317-846-6063
Practice Address - Street 1:1320 CITY CENTER DR STE 150
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3104
Practice Address - Country:US
Practice Address - Phone:574-293-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003841A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist