Provider Demographics
NPI:1669547444
Name:REED, KIMBERLY KAY (OD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:KAY
Last Name:REED
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:REED
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:3963 W LAKE ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3060
Mailing Address - Country:US
Mailing Address - Phone:954-423-3167
Mailing Address - Fax:
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:NSU THE EYE INSTITUTE SUITE 1402
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-1402
Practice Address - Fax:954-262-1818
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2454152W00000X
IA2335152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU43780Medicare UPIN
FL20443Medicare ID - Type Unspecified