Provider Demographics
NPI:1922106806
Name:KIMBALL, ORVIL V JR (OD)
Entity Type:Individual
Prefix:
First Name:ORVIL
Middle Name:V
Last Name:KIMBALL
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 CRENSHAW RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3628
Mailing Address - Country:US
Mailing Address - Phone:281-998-0500
Mailing Address - Fax:281-998-1689
Practice Address - Street 1:4415 CRENSHAW RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3628
Practice Address - Country:US
Practice Address - Phone:281-998-0500
Practice Address - Fax:281-998-1689
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2845TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112374702Medicaid
TX112374702Medicaid
TX00E44AMedicare PIN