Provider Demographics
NPI:1972881134
Name:ROSS, KYLE D (OD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:D
Last Name:ROSS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:N54W6135 MILL ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2021
Mailing Address - Country:US
Mailing Address - Phone:262-421-4412
Mailing Address - Fax:262-421-4413
Practice Address - Street 1:N54W6135 MILL ST
Practice Address - Street 2:SUITE 700
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-2021
Practice Address - Country:US
Practice Address - Phone:262-421-4412
Practice Address - Fax:262-421-4413
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2014-07-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI3226-035152W00000X
IL046010472152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist