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Individual
KIMBERLY A TEDDER
Active
Individual
KIMBERLY A TEDDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
13135T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477606945
ANTHEM BLUE CROSS
—
05
—
1477606945
—
CA
Enumeration date
01/19/2007
Last updated
10/07/2008
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