Provider Demographics
NPI:1992169247
Name:AVIRETT ZACHRY, KAYLA (OD)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:
Last Name:AVIRETT ZACHRY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:AVIRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:237 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4252
Mailing Address - Country:US
Mailing Address - Phone:830-257-6336
Mailing Address - Fax:
Practice Address - Street 1:237 W WATER ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4252
Practice Address - Country:US
Practice Address - Phone:830-257-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX9166TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program