Provider Demographics
NPI:1750300059
Name:SEBOK-STROCK, KIMBERLY A (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:SEBOK-STROCK
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:4281 24TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3997
Mailing Address - Country:US
Mailing Address - Phone:810-385-4000
Mailing Address - Fax:810-958-7379
Practice Address - Street 1:735 JOHN R RD STE 150
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5859
Practice Address - Country:US
Practice Address - Phone:248-577-3659
Practice Address - Fax:248-588-9917
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIL703477152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU64151Medicare UPIN