Provider Demographics
NPI:1396861167
Name:STEWART, KIMBERLY J
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:J
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901N BEDELL AVE E
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-4170
Mailing Address - Country:US
Mailing Address - Phone:830-775-2020
Mailing Address - Fax:830-775-4868
Practice Address - Street 1:6221 SLIDE RD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-4611
Practice Address - Country:US
Practice Address - Phone:806-791-3937
Practice Address - Fax:806-799-6069
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3737T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist