MEDICARE: DR. KIMBERLY ROSENTHAL TINGE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046008913	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508893264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY ROSENTHAL TINGE O.D.

Provider Business Mailing Address
First Line	:	132 OFALLON TROY RD
Second Line	:
City	:	O FALLON
State	:	IL
Zip	:	62269-6702
Country	:	US
Telephone Number	:	618-628-4446
Fax Number	:

Provider Business Practice Location Address
First Line	:	823 9TH ST
Second Line	:
City	:	HIGHLAND
State	:	IL
Zip	:	62249-1521
Country	:	US
Telephone Number	:	618-654-9848
Fax Number	:	618-654-5200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	05/26/2010

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Directions to “ DR. KIMBERLY ROSENTHAL TINGE O.D.” Practice Location

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