Individual
DR. STEPHEN WADE KIMMELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1400 TEAL RD STE 8, LAFAYETTE, IN 47905-2463
(317) 841-2020
Mailing address
9202 N MERIDIAN ST, INDIANAPOLIS, IN 46260-1800
(317) 841-2020
(317) 570-7433
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003407A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200974090A
—
IN
Enumeration date
08/23/2006
Last updated
07/02/2024
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