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General NPI Number Information
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NPI Number | 1477567147
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Entity Type | Individual
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Provider Name | LAURA M KIMBLE O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 6325 FALLS OF NEUSE RD STE 1
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City | RALEIGH
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State | NC
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Zip | 27615-6883
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Country | US
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Telephone | 919-876-1499
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Fax | 919-873-1926
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Provider Business Mailing Address
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Address Line | 12200 LOCKHART LN
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City | RALEIGH
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State | NC
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Zip | 27614-9405
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Country | US
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Telephone | 317-650-4210
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Fax | 919-873-1926
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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 | 2473
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License Number State | NC
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