Kimball, Dale W
Kimball, Dale W is an individual health care provider with primary practice located at 4575 La Jolla Village Dr , San Diego CA 92122-1203. He recently has 2 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Kimball, Dale W can be contacted via phone (858) 453-4112.Contact Information
Primary practice address
4575 La Jolla Village Dr
San Diego CA 92122-1203
Phone: (858) 453-4112
Fax: (858) 453-4398
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 6064T | California |
| Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | 6064T | California |
Profile Details
| NPI number | 1841355500 |
|---|---|
| LBN Legal business name | Kimball, Dale W |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 23rd, 2006 |
| Last updated | Aug 16th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1841355500 | NPPES |
| California | MEDICAID | SD0060642 |
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