Individual
DR. KYLE LANCE HIBBERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
US 191 & SR 264, GANADO, AZ 86505-7415
(928) 755-4500
Mailing address
PO BOX 781, WINDOW ROCK, AZ 86515-0781
(307) 696-3105
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
829
MT
152W00000X
Optometrist
Primary
OPT-002332
AZ
Other
Enumeration date
11/10/2011
Last updated
09/08/2020
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