Provider Demographics
NPI:1225081367
Name:HEFNER-POE, KIMBERLY SUE (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:SUE
Last Name:HEFNER-POE
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 1:5757 NW 132ND ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-4437
Mailing Address - Country:US
Mailing Address - Phone:405-728-8853
Mailing Address - Fax:405-728-8855
Practice Address - Street 1:5757 NW 132ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-4437
Practice Address - Country:US
Practice Address - Phone:405-728-8853
Practice Address - Fax:405-728-8855
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2039152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1154360001OtherPALMETTO
OKU18692Medicare UPIN
OK1154360001OtherPALMETTO