Provider Demographics
NPI:1568990919
Name:ROCK, KIMBERLY LYNN (OD, MS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:LYNN
Last Name:ROCK
Suffix:
Gender:F
Credentials:OD, MS
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:LYNN
Other - Last Name:RENNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD, MS
Mailing Address - Street 1:5688 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5688 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-8127
Practice Address - Country:US
Practice Address - Phone:614-853-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist