Provider Demographics
NPI:1518138650
Name:ORVIL V KIMBALL JR
Entity Type:Organization
Organization Name:ORVIL V KIMBALL JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ORVIL
Authorized Official - Middle Name:V
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:281-998-0500
Mailing Address - Street 1:4415 CRENSHAW RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3628
Mailing Address - Country:US
Mailing Address - Phone:281-998-0500
Mailing Address - Fax:281-998-1689
Practice Address - Street 1:4415 CRENSHAW RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3628
Practice Address - Country:US
Practice Address - Phone:281-998-0500
Practice Address - Fax:281-998-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2845TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0259650001Medicare NSC