NPIMap

Organization Active NPI

Glenn P Kimball

Doing business as Glenn P Kimball Jr MD LLC

  • Ophthalmology Physician
  • Haverhill, MA
National Provider Identifier
1689857328
Registry record updated Dec 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
57624 Issued in MA
Legal business name
GLENN P KIMBALL
Doing business as
Glenn P Kimball Jr MD LLC
Practice address
680 Main St
Haverhill, MA 01830-2644
Phone
(978) 374-4258
Fax
(978) 374-4982
NPI assigned
Dec 17, 2007
Last updated
Dec 5, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2018

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

Authorized official

Name
Glenn P Kimball Jr., M.DNPI 1265428924
Title
Owner
Phone
(978) 374-4258

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 1177510001 MA
Ophthalmology Physician 207W00000X 57624 MA Primary

Addresses

Primary practice location

680 Main St
Haverhill, MA 01830-2644

Mailing address

680 Main St
Haverhill, MA 01830-2644
Phone (978) 374-4258

Other names 1

  • Glenn P Kimball Jr MD LLC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1197849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543968000000",
    "number": "1689857328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 MAIN ST",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "018302644",
            "telephone_number": "978-374-4258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 MAIN ST",
            "city": "HAVERHILL",
            "state": "MA",
            "postal_code": "018302644",
            "telephone_number": "978-374-4258",
            "fax_number": "978-374-4982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN P KIMBALL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-17",
        "last_updated": "2018-12-05",
        "status": "A",
        "authorized_official_last_name": "KIMBALL",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "978-374-4258",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MA",
            "license": "1177510001",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MA",
            "license": "57624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glenn P Kimball Jr MD LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Haverhill, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2018; 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.