Provider Demographics
NPI:1720068778
Name:MCCASHEN, KYLE JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:JOHN
Last Name:MCCASHEN
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 1:1525 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-1593
Mailing Address - Country:US
Mailing Address - Phone:419-636-6723
Mailing Address - Fax:419-636-1704
Practice Address - Street 1:1525 W HIGH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1593
Practice Address - Country:US
Practice Address - Phone:419-636-6723
Practice Address - Fax:419-636-1704
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4477 T1133152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
OH4477 T1133152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Not Answered152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0199173Medicaid
OH03211OtherPARAMOUNT
OH0199173Medicaid
OHMC0778641Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
OH0963340001Medicare NSC
OHU45994Medicare UPIN