Organization
KYLE GWINNER OD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. G. KYLE GWINNER O.D. (OPTOMETRIST)
(785) 472-3272
Entity
Organization
Contact information
Practice address
801 E 3RD ST, ELLSWORTH, KS 67439-0339
(785) 472-3272
(785) 472-3360
Mailing address
PO BOX 339, ELLSWORTH, KS 67439-0339
(785) 472-3272
(785) 472-3360
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100090550D
—
KS
Enumeration date
02/14/2007
Last updated
09/04/2014
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