Physician Compare National (NPI:1558498543)

HEALTHCARE PROVIDER: KIMBERLY N. STUCKEY O.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1558498543
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3577795095
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20140416001768
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	STUCKEY
	Individual professional last name
Provider First Name	KIMBERLY
	Individual professional first name
Provider Middle Name	NGUYEN
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OHIO STATE UNIVERSITY - COLLEGE OF OPTOMETRY
	Individual professional's medical school
Graduation Year	2005
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	5335 HENDRON RD
	Group Practice or individual's line 1 address
City	GROVEPORT
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	431251055
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M