Healthcare Provider Details

I. General information

NPI: 1871013250
Provider Name (Legal Business Name): KIMBERLY ANNE ESPOSITO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY HARMON OD

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5780 FRANKLIN ST
MICHIGAN CITY IN
46360-7844
US

IV. Provider business mailing address

PO BOX 2081
VALPARAISO IN
46384-2081
US

V. Phone/Fax

Practice location:
  • Phone: 219-879-4390
  • Fax:
Mailing address:
  • Phone: 219-879-4390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046011129
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004058A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: