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General NPI Number Information
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NPI Number | 1417235417
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Entity Type | Individual
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Provider Name | KIMBERLY E BROWN O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 2751 FOUNTAIN PL SUITE 2
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City | WILDWOOD
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State | MO
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Zip | 63040-1202
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Country | US
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Telephone | 636-273-3910
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Fax | 636-273-3918
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Provider Business Mailing Address
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Address Line | 2751 FOUNTAIN PLACE SUITE 2
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City | WILDWOOD
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State | MO
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Zip | 63040-1202
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Country | US
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Telephone | 636-273-3910
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Fax | 636-273-3918
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2011018556
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License Number State | MO
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