Provider Demographics
NPI:1083013106
Name:DOBRODZIEJ, KIMBERLY A (OD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:DOBRODZIEJ
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 1:5 CHERRY CT
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4404
Mailing Address - Country:US
Mailing Address - Phone:315-368-4398
Mailing Address - Fax:
Practice Address - Street 1:206 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2627
Practice Address - Country:US
Practice Address - Phone:518-584-2620
Practice Address - Fax:518-584-3979
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008144152WC0802X, 152WP0200X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy