Provider Demographics
NPI:1609947001
Name:KIMMEL, PAMELA SUE (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:SUE
Last Name:KIMMEL
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 1:1977 STRATHMORE DR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8227
Mailing Address - Country:US
Mailing Address - Phone:484-788-8740
Mailing Address - Fax:
Practice Address - Street 1:1091 MILL CREEK RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106
Practice Address - Country:US
Practice Address - Phone:610-530-1519
Practice Address - Fax:610-530-1525
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001348152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01922244Medicaid
456730Medicare UPIN
PA01922244Medicaid