Provider Demographics
NPI:1306551494
Name:JUNTARASHINE, KIMBERLY
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:JUNTARASHINE
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 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:
Practice Address - Street 1:2791 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:DALLASTOWN
Practice Address - State:PA
Practice Address - Zip Code:17313-9540
Practice Address - Country:US
Practice Address - Phone:717-741-4788
Practice Address - Fax:717-801-1830
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003970152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist