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Individual

KIM DU BAHL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OD

Contact information

Practice address
5201 HARRY HINES BLVD, AMBULATORY CARE CLINIC, DALLAS, TX 75235-7708
(214) 590-5512
(214) 590-5491
Mailing address
PO BOX 660599, DALLAS, TX 75266-0599

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6541T
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
175625602
TX
01
81657Q
BLUE CROSS BLUE SHIELD
TX
01
P00298349
RAILROAD MEDICARE
Enumeration date
11/10/2005
Last updated
09/27/2012
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