Provider Demographics
NPI:1043385594
Name:MCDOWELL, KIMBERLY A (OD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:MCDOWELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S ABSAROKA ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2708
Mailing Address - Country:US
Mailing Address - Phone:307-754-2020
Mailing Address - Fax:307-754-2020
Practice Address - Street 1:106 S ABSAROKA ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2708
Practice Address - Country:US
Practice Address - Phone:307-754-2020
Practice Address - Fax:307-754-2020
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY219T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY120705901Medicaid
WY410025406OtherPALMETTO RAILROAD MEDICAR
WYW306541OtherMEDICARE ID-PIN
WYW306541OtherMEDICARE ID-PIN
WY0737720001Medicare NSC
WYW306541Medicare UPIN