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General NPI Number Information
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NPI Number | 1205909884
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Entity Type | Organization
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Legal Business Name | BLOUNT KIMBALL MEDICAL OPTOMETRY PA
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 125 N 5TH ST
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City | SILSBEE
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State | TX
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Zip | 77656-4030
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Country | US
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Telephone | 409-385-5262
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Fax | 409-385-6497
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Provider Business Mailing Address
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Address Line | 125 N 5TH ST
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City | SILSBEE
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State | TX
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Zip | 77656-4030
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Country | US
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Telephone | 409-385-5262
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Fax | 409-385-6497
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. LEIGH B KIMBALL
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Credential | OD
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Telephone | 409-899-9999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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