MEDICARE: DR. LIANN H KIMBALL OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	001038	CT

General Provider Information

NPI Number	:	1225024458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIANN H KIMBALL OD

Provider Business Mailing Address
First Line	:	1449 OLD WATERBURY RD
Second Line	:	SUITE 304
City	:	SOUTHBURY
State	:	CT
Zip	:	06488-3926
Country	:	US
Telephone Number	:	203-267-2020
Fax Number	:	203-267-2021

Provider Business Practice Location Address
First Line	:	1449 OLD WATERBURY RD
Second Line	:	SUITE 304
City	:	SOUTHBURY
State	:	CT
Zip	:	06488-3926
Country	:	US
Telephone Number	:	203-267-2020
Fax Number	:	203-267-2021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	02/23/2008

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