Provider Demographics
NPI:1437129558
Name:CRUISE, KIMBERLY KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:KAY
Last Name:CRUISE
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 1:915 ROBINS SQUARE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROBINS
Mailing Address - State:IA
Mailing Address - Zip Code:52328
Mailing Address - Country:US
Mailing Address - Phone:319-377-2222
Mailing Address - Fax:319-294-4299
Practice Address - Street 1:1065 EAST POST ROAD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302
Practice Address - Country:US
Practice Address - Phone:319-377-2222
Practice Address - Fax:319-377-2967
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02119152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA46561OtherBCBS
IA46560OtherBCBS
IA0461921Medicaid
IA40331OtherBCBS
410038361OtherRR MEDICARE
7396043OtherAETNA
IA0260340001Medicare NSC
IA0260340002Medicare NSC
IA0461921Medicaid
410038361OtherRR MEDICARE
IA46561OtherBCBS