Provider Demographics
NPI:1952009698
Name:WHITE, KIMBERLY ANN (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46440 US HIGHWAY 20
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074-9475
Mailing Address - Country:US
Mailing Address - Phone:440-774-6738
Mailing Address - Fax:440-774-6740
Practice Address - Street 1:1996 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-8944
Practice Address - Country:US
Practice Address - Phone:419-281-5528
Practice Address - Fax:419-281-5146
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.014730-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician