Provider Demographics
NPI:1174515985
Name:DOTSON, KYLE BRENT (OD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:BRENT
Last Name:DOTSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 SE 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-2461
Mailing Address - Country:US
Mailing Address - Phone:785-266-3240
Mailing Address - Fax:
Practice Address - Street 1:2211 SE 29TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-2461
Practice Address - Country:US
Practice Address - Phone:785-266-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1135-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS5335OtherBLUE CROSS
T43762Medicare UPIN
KS005335Medicare PIN
KS0171970001Medicare NSC