Provider Demographics
NPI:1992852289
Name:NORDIN, KIMBERLY W (OD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:W
Last Name:NORDIN
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 1:917 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1407
Mailing Address - Country:US
Mailing Address - Phone:606-788-0433
Mailing Address - Fax:606-789-5053
Practice Address - Street 1:917 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1407
Practice Address - Country:US
Practice Address - Phone:606-788-0433
Practice Address - Fax:606-789-5053
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1176DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77011765Medicaid
KY9392001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
KY9304701Medicare PIN
KY77011765Medicaid
KY9317902Medicare PIN