Provider Demographics
NPI:1952566721
Name:KIMBLE, ASHLEY ZAK (OD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:ZAK
Last Name:KIMBLE
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 1:15508 W COLONIAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-9557
Mailing Address - Country:US
Mailing Address - Phone:954-849-4656
Mailing Address - Fax:
Practice Address - Street 1:15508 W COLONIAL DR STE 102
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9557
Practice Address - Country:US
Practice Address - Phone:407-798-8880
Practice Address - Fax:407-798-8810
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4399152WP0200X, 152WV0400X
FL4399152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000236600Medicaid
FL000236600Medicaid