Provider Demographics
NPI:1477567147
Name:KIMBLE, LAURA M (OD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12200 LOCKHART LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-9405
Mailing Address - Country:US
Mailing Address - Phone:317-650-4210
Mailing Address - Fax:919-873-1926
Practice Address - Street 1:6325 FALLS OF NEUSE RD STE 1
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6883
Practice Address - Country:US
Practice Address - Phone:919-876-1499
Practice Address - Fax:919-873-1926
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2473152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01954640Medicaid
PA01954640Medicaid
PA071864Medicare ID - Type Unspecified