Individual
DR. KYLE J ANTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
301 J ST, LAPORTE, IN 46350
(219) 362-8923
(219) 324-8183
Mailing address
301 J ST, LAPORTE, IN 46350-4734
(219) 362-8923
(219) 324-8183
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003609A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200953020
—
IN
Enumeration date
06/30/2009
Last updated
08/14/2018
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