Provider Demographics
NPI:1912034844
Name:PLATTNER, KIMBERLY B (OD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:B
Last Name:PLATTNER
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:PO BOX 1457
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-1457
Mailing Address - Country:US
Mailing Address - Phone:619-742-3937
Mailing Address - Fax:858-756-2804
Practice Address - Street 1:5990 SANTO RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-1192
Practice Address - Country:US
Practice Address - Phone:858-571-8835
Practice Address - Fax:858-571-6364
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9399TPG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU13901Medicare UPIN
CAWOP9399HMedicare ID - Type UnspecifiedMEDICARE (TIERRASANTA)