Provider Demographics
NPI:1215403027
Name:MAY, KIMBERLY LAUREN BALLARD (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:LAUREN BALLARD
Last Name:MAY
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 1:1416 E WOOD ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5606
Mailing Address - Country:US
Mailing Address - Phone:731-642-1450
Mailing Address - Fax:731-642-1545
Practice Address - Street 1:1416 E WOOD ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5606
Practice Address - Country:US
Practice Address - Phone:731-642-1450
Practice Address - Fax:731-642-1545
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN-3501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist