Provider Demographics
NPI:1659479624
Name:ALLEN, KIMBERLY D (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:D
Last Name:ALLEN
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 1:29 DIRIGO DRIVE
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1600
Mailing Address - Country:US
Mailing Address - Phone:207-942-2015
Mailing Address - Fax:207-945-6528
Practice Address - Street 1:29 DIRIGO DRIVE
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1600
Practice Address - Country:US
Practice Address - Phone:207-942-2015
Practice Address - Fax:207-945-6528
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT871152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME421870099Medicaid
ME061532OtherANTHEM BLUE CROSS
ME421870099Medicaid
MEWOME1157Medicare ID - Type Unspecified