Provider Demographics
NPI:1881786978
Name:PEARL, KIMBERLY E (OD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:E
Last Name:PEARL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:E
Other - Last Name:HACKWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4905 BRADSHAW ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-1429
Mailing Address - Country:US
Mailing Address - Phone:913-687-0032
Mailing Address - Fax:
Practice Address - Street 1:2144 SW 36TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-2554
Practice Address - Country:US
Practice Address - Phone:785-266-1010
Practice Address - Fax:785-266-5312
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1620152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS912680Medicaid