Individual
DR. KYLE M CHEATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O. D.
Contact information
Practice address
2514 W BROADWAY, COUNCIL BLUFFS, IA 51501-3509
(712) 322-3097
(712) 322-4130
Mailing address
2514 W BROADWAY, COUNCIL BLUFFS, IA 51501-3509
(711) 322-3097
(712) 322-4130
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
02373
IA
152W00000X
Optometrist
1267
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0790470
—
IA
05
—
10025382400
—
NE
01
—
32830
BCBS OF IA
IA
01
—
37153
BCBS OF NE
NE
01
—
37192
BCBS OF NE
NE
01
—
614965001
DMERC
IA
01
—
99644
BCBS
IA
01
—
99831
BCBS
IA
01
—
P00397521
PALMETTO RAILROAD
NE
Enumeration date
09/16/2006
Last updated
09/12/2025
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