Provider Demographics
NPI:1407054943
Name:LAYFIELD, KIMBERLY ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:LAYFIELD
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 1:262 VALLEYBROOK CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-9638
Mailing Address - Country:US
Mailing Address - Phone:314-956-7227
Mailing Address - Fax:
Practice Address - Street 1:12255 DEPAUL DRIVE
Practice Address - Street 2:SUITE 360
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2510
Practice Address - Country:US
Practice Address - Phone:314-739-9293
Practice Address - Fax:314-739-3968
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007018394152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO317423705Medicaid
MO260945186Medicare PIN
MO317423705Medicaid