Provider Demographics
NPI:1437312717
Name:KEPNER, KIMBERLY S (OD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:KEPNER
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 1:14712 BAUER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3423 OLNEY LAYTONSVILLE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1787
Practice Address - Country:US
Practice Address - Phone:301-774-2434
Practice Address - Fax:301-774-0312
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1039152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist