Provider Demographics
NPI:1972909679
Name:BALK, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BALK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 E 650TH AVE
Mailing Address - Street 2:
Mailing Address - City:ARMA
Mailing Address - State:KS
Mailing Address - Zip Code:66712-9538
Mailing Address - Country:US
Mailing Address - Phone:620-875-6748
Mailing Address - Fax:
Practice Address - Street 1:411 E CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6505
Practice Address - Country:US
Practice Address - Phone:620-232-1005
Practice Address - Fax:620-231-5821
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS190554156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician