Provider Demographics
NPI:1902938715
Name:KIVLE, ROBERT HALLAND (OD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:HALLAND
Last Name:KIVLE
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:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:ASOTIN
Mailing Address - State:WA
Mailing Address - Zip Code:99402
Mailing Address - Country:US
Mailing Address - Phone:509-243-9530
Mailing Address - Fax:
Practice Address - Street 1:301 5TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403
Practice Address - Country:US
Practice Address - Phone:509-758-0205
Practice Address - Fax:509-751-0610
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1374TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist