Provider Demographics
NPI:1740393602
Name:KIMBALL, LEIGH B (OD)
Entity Type:Individual
Prefix:DR
First Name:LEIGH
Middle Name:B
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4105 DOWLEN RD STE B
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-6871
Mailing Address - Country:US
Mailing Address - Phone:409-899-9999
Mailing Address - Fax:409-892-6587
Practice Address - Street 1:4105 DOWLEN RD STE B
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6871
Practice Address - Country:US
Practice Address - Phone:409-899-9999
Practice Address - Fax:409-892-6587
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4825T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4825TOtherSTATE LICENSE
TXMB0420339OtherDEA
TXMB0420339OtherDEA
TX83251EMedicare ID - Type Unspecified