Provider Demographics
NPI:1053328864
Name:KIMBALL, JULIA D (OD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:D
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:D
Other - Last Name:LAMPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:
Practice Address - Street 1:12605 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2545
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1482152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1482OtherSTATE LICENSE NUMBER
CO1482OtherSTATE LICENSE NUMBER
COU16501Medicare UPIN