Provider Demographics
NPI:1942340070
Name:DR. WILLIAM E. KIMBALL AND LIANN H. KIMBALL, OD'S, PARTNERS
Entity Type:Organization
Organization Name:DR. WILLIAM E. KIMBALL AND LIANN H. KIMBALL, OD'S, PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-744-3730
Mailing Address - Street 1:290 JACOB RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2719
Mailing Address - Country:US
Mailing Address - Phone:203-264-7720
Mailing Address - Fax:
Practice Address - Street 1:15 BACKUS AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7431
Practice Address - Country:US
Practice Address - Phone:203-744-3730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1038152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02070Medicare ID - Type UnspecifiedGROUP NUMBER