NPIMap

Organization Active NPI

Kyle Sexton, O.D., LLC

  • Optometrist
  • Puyallup, WA
National Provider Identifier
1972778009
Registry record updated Apr 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
KYLE SEXTON, O.D., LLC
Practice address
3500 S Meridian
Space 945
Puyallup, WA 98373-3779
Phone
(253) 864-9353
Fax
(253) 864-9355
NPI assigned
Apr 29, 2008
Last updated
Apr 29, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kyle Sexton, O.D.NPI 1922108950
Title
Owner
Phone
(253) 864-9353

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

3500 S Meridian
Space 945
Puyallup, WA 98373-3779

Mailing address

3500 S Meridian
Space 945
Puyallup, WA 98373-3779
Phone (253) 864-9353

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080515000755 WA Part B Supplier - Clinic/Group Practice 1951470913 Receives reassigned benefits from 16 practitioners
Practice locations: Puyallup, WA

National Provider Directory

National Provider Directory

Locations

3500 S Meridian
Ste 926
Puyallup, WA 98373
Phone (253) 864-9350

3500 S Meridian
Ste 945
Puyallup, WA 98373
Phone (253) 864-9353

4750 N Division St
Ste 1010
Spokane, WA 99207
Phone (509) 596-9879

14700 E Indiana Ave
Spc 1008
Spokane Valley, WA 99216
Phone (509) 596-9880

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1972778009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 S MERIDIAN",
            "address_2": "SPACE 945",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733779",
            "telephone_number": "253-864-9353",
            "fax_number": "253-864-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 S MERIDIAN",
            "address_2": "SPACE 945",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983733779",
            "telephone_number": "253-864-9353",
            "fax_number": "253-864-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KYLE SEXTON, O.D., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "SEXTON",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-864-9353",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.