Provider Demographics
NPI:1043706377
Name:CENTORE, KYLIE ANN
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:ANN
Last Name:CENTORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:ANN
Other - Last Name:AUMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:220 E MCMURRAY RD STE B
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2948
Mailing Address - Country:US
Mailing Address - Phone:724-942-1300
Mailing Address - Fax:
Practice Address - Street 1:220 E MCMURRAY RD
Practice Address - Street 2:
Practice Address - City:CANONSBURG
Practice Address - State:PA
Practice Address - Zip Code:15317-2948
Practice Address - Country:US
Practice Address - Phone:724-942-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2024-07-08
Deactivation Date:2024-04-29
Deactivation Code:
Reactivation Date:2024-06-04
Provider Licenses
StateLicense IDTaxonomies
PAOEG003414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist