Provider Demographics
NPI:1316357569
Name:LAAN, KIMBERLY PENIX (OD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PENIX
Last Name:LAAN
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 1:601 PROVIDENCE PARK DR E
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4617
Mailing Address - Country:US
Mailing Address - Phone:251-650-2020
Mailing Address - Fax:251-650-1010
Practice Address - Street 1:601 PROVIDENCE PARK DR E
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4617
Practice Address - Country:US
Practice Address - Phone:251-650-2020
Practice Address - Fax:251-650-1010
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00000152W00000X
MN3450152W00000X
ALT-214-TA-975152W00000X
ALS-D45-TA-975152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist