Healthcare Provider Details

I. General information

NPI: 1427362359
Provider Name (Legal Business Name): KIMBERLY M CHANEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 LAKELAND HILLS BLVD
LAKELAND FL
33805
US

IV. Provider business mailing address

38135 MARKET SQ
ZEPHYRHILLS FL
33542-7505
US

V. Phone/Fax

Practice location:
  • Phone: 863-687-2260
  • Fax:
Mailing address:
  • Phone: 813-528-4975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4866
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: