Provider Demographics
NPI:1417235417
Name:BROWN, KIMBERLY E (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:E
Last Name:BROWN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:E
Other - Last Name:FOLWARSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2751 FOUNTAIN PLACE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1202
Mailing Address - Country:US
Mailing Address - Phone:636-273-3910
Mailing Address - Fax:636-273-3918
Practice Address - Street 1:2751 FOUNTAIN PL
Practice Address - Street 2:SUITE 2
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1202
Practice Address - Country:US
Practice Address - Phone:636-273-3910
Practice Address - Fax:636-273-3918
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011018556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist