Healthcare Provider Details

I. General information

NPI: 1922289552
Provider Name (Legal Business Name): KIMBERLY LEE WAMPLER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 W WHITESTONE BLVD STE 100
CEDAR PARK TX
78613-7958
US

IV. Provider business mailing address

908 W WHITESTONE BLVD STE 100
CEDAR PARK TX
78613-7958
US

V. Phone/Fax

Practice location:
  • Phone: 512-259-2020
  • Fax: 737-212-9283
Mailing address:
  • Phone: 512-259-2020
  • Fax: 737-212-9283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number7160TG
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7160TG
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number7160TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: