Individual provider Active NPI

William E Kimball, OD

  • Optometrist
  • Southbury, CT
National Provider Identifier
1205822426
Registry record updated Feb 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
001088 Issued in CT
Practice address
1449 Old Waterbury Rd
Suite 304
Southbury, CT 06488-3926
Phone
(203) 267-2020
Fax
(203) 267-2021
NPI assigned
Sep 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 001088 CT Primary

Addresses

Primary practice location

1449 Old Waterbury Rd
Suite 304
Southbury, CT 06488-3926

Mailing address

1449 Old Waterbury Rd
Suite 304
Southbury, CT 06488-3926
Phone (203) 267-2020

Other identifiers 1

IdentifierTypeStateIssuer
4063194MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
001088CTMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. William E. Kimball and Liann H. Kimball, OD'S, Partners Optometrist PastSince May 3, 2005 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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203724800000",
    "number": "1205822426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1449 OLD WATERBURY RD",
            "address_2": "SUITE 304",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064883926",
            "telephone_number": "203-267-2020",
            "fax_number": "203-267-2021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1449 OLD WATERBURY RD",
            "address_2": "SUITE 304",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064883926",
            "telephone_number": "203-267-2020",
            "fax_number": "203-267-2021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "WILLIAM",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-22",
        "last_updated": "2008-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "001088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4063194",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.