Provider Demographics
NPI:1083614747
Name:STEELE, KIMBERLY A (OD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:STEELE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:MISTISZYN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3575 BRIDGE RD STE 19
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1844
Mailing Address - Country:US
Mailing Address - Phone:757-638-2015
Mailing Address - Fax:757-638-2010
Practice Address - Street 1:3575 BRIDGE RD STE 19
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1844
Practice Address - Country:US
Practice Address - Phone:757-638-2015
Practice Address - Fax:757-638-2010
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001251152W00000X
VA0618002651152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1083614747Medicaid
PAV03949Medicare UPIN