Provider Demographics
NPI:1740356567
Name:TOM, KIMBERLY A (OD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:TOM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4017 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3715
Mailing Address - Country:US
Mailing Address - Phone:415-821-3937
Mailing Address - Fax:415-821-5896
Practice Address - Street 1:4017 24TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3715
Practice Address - Country:US
Practice Address - Phone:415-821-3937
Practice Address - Fax:415-821-5896
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9718T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist