Provider Demographics
NPI:1760473805
Name:PADILLA, KERRIE LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:KERRIE
Middle Name:LYNN
Last Name:PADILLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:KERRIE
Other - Middle Name:LYNN
Other - Last Name:BOSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2817 REILLY ROAD MCXC COD CREDENTIALS
Mailing Address - Street 2:WOMACK ARMY MEDICAL CENTER
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-8952
Mailing Address - Country:US
Mailing Address - Phone:910-907-8922
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:WOMACK ARMY MEDICAL CTR
Practice Address - Street 2:JOEL HEALTH CLINIC OPTOMETRY LOGISTICS RD
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-6587
Practice Address - Fax:910-643-2432
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003018486152W00000X
OK2398152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist