Provider Demographics
NPI:1932209731
Name:KILE, KRISTOPHER TRENTON (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:TRENTON
Last Name:KILE
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:PO BOX 167
Mailing Address - Street 2:135 FREEPORT AVE.
Mailing Address - City:POINT LOOKOUT
Mailing Address - State:NY
Mailing Address - Zip Code:11569-0167
Mailing Address - Country:US
Mailing Address - Phone:516-432-4909
Mailing Address - Fax:631-206-0236
Practice Address - Street 1:1701 SUNRISE HWY
Practice Address - Street 2:JC PENNEY OPTICAL SOUTH SHORE MALL
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6091
Practice Address - Country:US
Practice Address - Phone:631-206-0236
Practice Address - Fax:631-206-0236
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005790-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC197A1Medicare ID - Type Unspecified
NYC21601Medicare ID - Type Unspecified