Provider Demographics
NPI:1114903937
Name:CARR-YEATES, KIMBERLY A (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:CARR-YEATES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:YEATES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1510 COOPER POINT RD SW
Mailing Address - Street 2:STE 110
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5734
Mailing Address - Country:US
Mailing Address - Phone:360-489-0493
Mailing Address - Fax:360-943-9424
Practice Address - Street 1:1510 COOPER POINT RD SW
Practice Address - Street 2:STE 110
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5734
Practice Address - Country:US
Practice Address - Phone:360-489-0493
Practice Address - Fax:360-943-9424
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3197TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8865194Medicare PIN
WAU81829Medicare UPIN