Provider Demographics
NPI:1508893264
Name:TINGE, KIMBERLY ROSENTHAL (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ROSENTHAL
Last Name:TINGE
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 1:132 OFALLON TROY RD
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6702
Mailing Address - Country:US
Mailing Address - Phone:618-628-4446
Mailing Address - Fax:
Practice Address - Street 1:823 9TH ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1521
Practice Address - Country:US
Practice Address - Phone:618-654-9848
Practice Address - Fax:618-654-5200
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008913152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008913Medicaid
IL1508893264Medicare NSC
IL046008913Medicaid
IL0152660001Medicare NSC