Individual
KYLIE SEBASTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1601 W LINCOLN RD, KOKOMO, IN 46902-3275
(765) 453-5696
(765) 455-4323
Mailing address
PO BOX 549, WABASH, IN 46992-0549
(260) 569-9550
(260) 569-0760
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003966
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201364070
—
IN
01
—
P01707911
RAILROAD MEDICARE
IN
Enumeration date
06/08/2016
Last updated
12/07/2017
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