Provider Demographics
NPI:1619549565
Name:FAZIO, KIMBERLY ROSE (OD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ROSE
Last Name:FAZIO
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1816 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-5920
Mailing Address - Country:US
Mailing Address - Phone:412-368-4400
Mailing Address - Fax:123-684-0914
Practice Address - Street 1:1816 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-5920
Practice Address - Country:US
Practice Address - Phone:412-368-4400
Practice Address - Fax:412-368-4091
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOEG003774152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist