Provider Demographics
NPI:1578614079
Name:MERRYFIELD, KIMBERLY (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:MERRYFIELD
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 1:2025 25 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-0941
Mailing Address - Country:US
Mailing Address - Phone:248-651-3937
Mailing Address - Fax:248-659-4361
Practice Address - Street 1:2025 25 MILE RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-0941
Practice Address - Country:US
Practice Address - Phone:248-651-3937
Practice Address - Fax:248-651-5006
Is Sole Proprietor?:No
Enumeration Date:2007-01-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004068152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901004068OtherOPTOMETRIST LICENSE
MI5330000693OtherMI CONTROLLED SUBSTANCE
MI5330000693OtherMI CONTROLLED SUBSTANCE
MI4901004068OtherOPTOMETRIST LICENSE
U81511Medicare UPIN