Provider Demographics
NPI:1871975367
Name:KNOBBE, KYLER DREW (OD)
Entity type:Individual
Prefix:DR
First Name:KYLER
Middle Name:DREW
Last Name:KNOBBE
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 1:1405 W US HIGHWAY 24
Mailing Address - Street 2:
Mailing Address - City:WAMEGO
Mailing Address - State:KS
Mailing Address - Zip Code:66547-1256
Mailing Address - Country:US
Mailing Address - Phone:785-456-8900
Mailing Address - Fax:
Practice Address - Street 1:1405 W US HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:WAMEGO
Practice Address - State:KS
Practice Address - Zip Code:66547-1256
Practice Address - Country:US
Practice Address - Phone:785-456-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2008152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management