MEDICARE: MRS. KIMBERLY W STROUP 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	S-C66-TA-892	AL

General Provider Information

NPI Number	:	1518252584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY W STROUP O.D.

Provider Business Mailing Address
First Line	:	4247 CANDLE BROOK LN
Second Line	:
City	:	BESSEMER
State	:	AL
Zip	:	35022-8342
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	911 HARGROVE RD E
Second Line	:
City	:	TUSCALOOSA
State	:	AL
Zip	:	35405-1602
Country	:	US
Telephone Number	:	205-507-7810
Fax Number	:	205-554-7399

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

Provider Enumeration Date	:	06/17/2011
Last Update Date	:	09/24/2018

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