Provider Demographics
NPI:1962580217
Name:BRODIE, KYLE A (OD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:A
Last Name:BRODIE
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:955 COMMERCE DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5261
Mailing Address - Country:US
Mailing Address - Phone:419-931-2020
Mailing Address - Fax:419-873-1445
Practice Address - Street 1:955 COMMERCE DR
Practice Address - Street 2:SUITE 4
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5261
Practice Address - Country:US
Practice Address - Phone:419-931-2020
Practice Address - Fax:419-873-1445
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH4547152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0771588Medicare PIN