Provider Demographics
NPI:1669853701
Name:KIMREY, AJA LEIGH (OD)
Entity Type:Individual
Prefix:
First Name:AJA
Middle Name:LEIGH
Last Name:KIMREY
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 1:8406 OLD SAUK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-4367
Mailing Address - Country:US
Mailing Address - Phone:608-833-7256
Mailing Address - Fax:608-833-0118
Practice Address - Street 1:8406 OLD SAUK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-4367
Practice Address - Country:US
Practice Address - Phone:608-833-7256
Practice Address - Fax:608-833-0118
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3377-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist