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Contact Information

KYLE J KENISON, OD
855 WEST 6TH SOUTH
MOUNTAIN HOME, ID83647
 Phone: 208-587-2020
 Fax: 208-587-3349
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for KYLE J KENISON · (Male)

NPI # 1750370730
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 10/21/2005
Last updated 03/15/2017 - About 9 years ago
Sole proprietor 1 No
Identifiers
  • MT License # MT 587
  • ID Medicaid 1750370730
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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