Provider Demographics
NPI:1578313391
Name:MUNSON, KIMBERLY CHARLENE (OD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:CHARLENE
Last Name:MUNSON
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 1:1901 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4019
Mailing Address - Country:US
Mailing Address - Phone:406-530-4604
Mailing Address - Fax:
Practice Address - Street 1:2203 BROADWATER AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-4713
Practice Address - Country:US
Practice Address - Phone:406-652-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOPT-OPT-LIC-5216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist