Provider Demographics
NPI:1518252584
Name:STROUP, KIMBERLY W (OD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:W
Last Name:STROUP
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 1:4247 CANDLE BROOK LN
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-8342
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:911 HARGROVE RD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-1602
Practice Address - Country:US
Practice Address - Phone:205-507-7810
Practice Address - Fax:205-554-7399
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-C66-TA-892152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist