Healthcare Provider Details

I. General information

NPI: 1205909884
Provider Name (Legal Business Name): BLOUNT KIMBALL MEDICAL OPTOMETRY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N 5TH ST
SILSBEE TX
77656-4030
US

IV. Provider business mailing address

125 N 5TH ST
SILSBEE TX
77656-4030
US

V. Phone/Fax

Practice location:
  • Phone: 409-385-5262
  • Fax: 409-385-6497
Mailing address:
  • Phone: 409-385-5262
  • Fax: 409-385-6497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. LEIGH B KIMBALL
Title or Position: OPTOMETRIST
Credential: OD
Phone: 409-899-9999