Provider Demographics
NPI:1508820721
Name:HINSON, KIMBERLY K (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:K
Last Name:HINSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:K
Other - Last Name:HINSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX
Mailing Address - Street 2:102635
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2635
Mailing Address - Country:US
Mailing Address - Phone:843-705-3333
Mailing Address - Fax:843-705-3334
Practice Address - Street 1:4 OKATIE CTR BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-7529
Practice Address - Country:US
Practice Address - Phone:843-705-3333
Practice Address - Fax:843-705-3334
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC997152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1376582916OtherMEDICARE RAILROAD
SCDA9642Medicaid
SC9143OtherSC MEDICARE GROUP
SCD09970Medicaid
SCU607949143Medicare PIN
SCU607945109Medicare PIN
SCDA9642Medicaid
SCP00407670Medicare PIN