Individual
KYLE SCOTT BOTHWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1240 W SOUTHERN AVE STE 101, MESA, AZ 85202-4882
(480) 655-0741
Mailing address
3906 E PAGE AVE, GILBERT, AZ 85234-4423
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
002585
AZ
152WP0200X
Pediatric Optometrist
002585
AZ
Other
Enumeration date
06/20/2022
Last updated
06/20/2022
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