Active NPI
Denton Larmarr Kimball, O.D.
- Optometrist
- San Marcos, CA
National Provider Identifier
1982745147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT5711
- Practice address
- 1 Civic Center Dr
130
San Marcos, CA 92069-2918 - Phone
- (760) 744-2611
- Fax
- (760) 744-2611
- NPI assigned
- Feb 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | OPT5711 | CA | Primary |
Addresses
Primary practice location
1 Civic Center Dr
130
San Marcos, CA 92069-2918
Mailing address
43965 Barletta St
Temecula, CA 92592-3947
Phone (951) 302-9908
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4146926 | Other | CA | MEDICAL |
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
| License | State | Type | Specialty |
|---|---|---|---|
| OPT5711 | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407801600000",
"number": "1982745147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "43965 BARLETTA ST",
"city": "TEMECULA",
"state": "CA",
"postal_code": "925923947",
"telephone_number": "951-302-9908"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 CIVIC CENTER DR",
"address_2": "130",
"city": "SAN MARCOS",
"state": "CA",
"postal_code": "920692918",
"telephone_number": "760-744-2611",
"fax_number": "760-744-2611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBALL",
"first_name": "DENTON",
"middle_name": "LARMARR",
"name_prefix": "Mr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-09",
"last_updated": "2014-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "OPT5711",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL",
"identifier": "4146926",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Marcos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.