Provider Demographics
NPI:1699121194
Name:BLAIR, KYLE COX (DO)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:COX
Last Name:BLAIR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2454 E DEMPSTER ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5320
Mailing Address - Country:US
Mailing Address - Phone:541-990-5464
Mailing Address - Fax:847-390-0616
Practice Address - Street 1:2454 E DEMPSTER ST STE 400
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-5320
Practice Address - Country:US
Practice Address - Phone:847-299-0700
Practice Address - Fax:847-390-0616
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.159412207W00000X, 207WX0107X
OR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program