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General NPI Number Information
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NPI Number | 1558498543
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Entity Type | Individual
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Provider Name | KIMBERLY N. STUCKEY O.D.
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 06/19/2014
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Provider Practice Location Address
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Address Line | 5335 HENDRON RD
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City | GROVEPORT
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State | OH
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Zip | 43125-1055
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Country | US
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Telephone | 614-836-9669
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Fax | 614-836-9703
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Provider Business Mailing Address
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Address Line | 5335 HENDRON RD
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City | GROVEPORT
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State | OH
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Zip | 43125-1055
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Country | US
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Telephone | 614-836-9669
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Fax | 614-836-9703
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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 | 5682
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License Number State | OH
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