Provider Demographics
NPI:1164315131
Name:DELK, KYLE JAMES (OD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:JAMES
Last Name:DELK
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 1:42215 CUBIERTO TRCE
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-7155
Mailing Address - Country:US
Mailing Address - Phone:409-626-1421
Mailing Address - Fax:
Practice Address - Street 1:18000 FM 1488 RD STE 100
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-8522
Practice Address - Country:US
Practice Address - Phone:281-252-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11299152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist