Provider Demographics
NPI:1912075805
Name:OSBORNE, KIMBERLY CROWLEY (OD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CROWLEY
Last Name:OSBORNE
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 1:8450 GREYLOCK CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-5902
Mailing Address - Country:US
Mailing Address - Phone:817-750-6531
Mailing Address - Fax:
Practice Address - Street 1:6401 NE LOOP 820 STE A
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6082
Practice Address - Country:US
Practice Address - Phone:817-788-5075
Practice Address - Fax:817-788-5066
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5745TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00916UMedicare ID - Type UnspecifiedCORPORATION MEDICARE #
TX8A5558Medicare ID - Type UnspecifiedPERSONAL MEDICARE #