Provider Demographics
NPI:1134376031
Name:DO, OLIVIA KIMBERLY (OD, FAAO)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:KIMBERLY
Last Name:DO
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 PEARL ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5001
Mailing Address - Country:US
Mailing Address - Phone:858-291-8485
Mailing Address - Fax:
Practice Address - Street 1:702 PEARL ST
Practice Address - Street 2:SUITE G
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5001
Practice Address - Country:US
Practice Address - Phone:908-938-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13697152W00000X
NYTUV007394-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFY215ZOtherMEDICARE PTAN
CAA12066OtherEYEMED