Healthcare Provider Details

I. General information

NPI: 1881786978
Provider Name (Legal Business Name): KIMBERLY E PEARL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY E HACKWORTH O.D.

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 MASSACHUSETTS ST
LAWRENCE KS
66044-2923
US

IV. Provider business mailing address

6120 JOHNSON DR
MISSION KS
66202-3333
US

V. Phone/Fax

Practice location:
  • Phone: 785-843-3844
  • Fax:
Mailing address:
  • Phone: 913-262-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1620
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: