Active NPI
Aimee Robinson Kinnebrew
- Optometrist
- Vicksburg, MS
National Provider Identifier
1205719630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1122
- Practice address
- 1808 Mission 66
Vicksburg, MS 39180-3710 - Phone
- (601) 636-6364
- Fax
- (601) 636-1122
- NPI assigned
- Jul 31, 2025
- Last updated
- Jul 31, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1122 | MS | Primary |
Addresses
Primary practice location
1808 Mission 66
Vicksburg, MS 39180-3710
Mailing address
1808 Mission 66
Vicksburg, MS 39180-3710
Phone (601) 636-6364
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Southern College of Optometry, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1808 Mission
Suite 66
Vicksburg, MS 39180-3710
Phone (601) 636-6364
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1122 | MS | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Vision Clinic of Vicksburg LLC | Optometrist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Optometrist
- Vicksburg, MS
- NPI 1871602862
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1753920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1753920000000",
"number": "1205719630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1808 MISSION 66",
"city": "VICKSBURG",
"state": "MS",
"postal_code": "391803710",
"telephone_number": "601-636-6364",
"fax_number": "601-636-3710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1808 MISSION 66",
"city": "VICKSBURG",
"state": "MS",
"postal_code": "391803710",
"telephone_number": "601-636-6364",
"fax_number": "601-636-1122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KINNEBREW",
"first_name": "AIMEE",
"middle_name": "ROBINSON",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-07-31",
"last_updated": "2025-07-31",
"certification_date": "2025-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MS",
"license": "1122",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vicksburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.