Provider Demographics
NPI:1760501456
Name:RAYMOND, KIMBERLY ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:RAYMOND
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 1:3923 S 48TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-4318
Mailing Address - Country:US
Mailing Address - Phone:402-488-3106
Mailing Address - Fax:402-488-3329
Practice Address - Street 1:3923 S 48TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-4318
Practice Address - Country:US
Practice Address - Phone:402-488-3106
Practice Address - Fax:402-488-3329
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1227152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1306019062OtherMEDICARE WPS
NE10025701100Medicaid
NE1306019062OtherMEDICARE RAILROAD
NE1306019062OtherMEDICARE WPS