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General NPI Number Information
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NPI Number | 1417001009
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Entity Type | Organization
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Legal Business Name | KIMBERLING VISION CENTER, INC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 1 WOODLAND AVE STE 2
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City | KIMBERLING CITY
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State | MO
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Zip | 65686-9738
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Country | US
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Telephone | 417-739-2411
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Fax | 417-739-2407
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Provider Business Mailing Address
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Address Line | 1 WOODLAND AVE STE 2
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City | KIMBERLING CITY
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State | MO
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Zip | 65686-9738
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Country | US
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Telephone | 417-739-2411
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Fax | 417-739-2407
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Authorized Official
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Title or Position | CHAIRMAN OF THE BOARD
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Name | DR. DEBRA LYNNE WILLIAMS
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Credential | O.D.
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Telephone | 417-739-2411
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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 | MOTO3116
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License Number State | MO
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