Provider Demographics
NPI:1316178155
Name:BRUNK, KIMBERLEY ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:ANN
Last Name:BRUNK
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 1:1022 EAST RAY FINE BOULEVARD SUITE 5
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74954
Mailing Address - Country:US
Mailing Address - Phone:918-427-3937
Mailing Address - Fax:
Practice Address - Street 1:1022 EAST RAY FINE BOULEVARD SUITE 5
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:OK
Practice Address - Zip Code:74954
Practice Address - Country:US
Practice Address - Phone:918-427-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2597152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist