Provider Demographics
NPI:1285026021
Name:ALLISON, KIMBERLY A
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:ALLISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:MARCUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 E ALEX BELL RD
Mailing Address - Street 2:SUTIE 120
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2753
Mailing Address - Country:US
Mailing Address - Phone:937-435-2437
Mailing Address - Fax:937-435-2437
Practice Address - Street 1:101 E ALEX BELL RD
Practice Address - Street 2:SUTIE 120
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2753
Practice Address - Country:US
Practice Address - Phone:937-435-2437
Practice Address - Fax:937-435-2437
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.7422156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician