Organization
KD OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIMBERLY D MOORE LICENSED OPTICIAN (OWNER/ LICENSED OPTICIAN)
(843) 821-9150
Entity
Organization
Contact information
Practice address
447 RAILROAD AVE, RIDGEVILLE, SC 29472
(843) 821-9150
Mailing address
447 RAILROAD AVE, RIDGEVILLE, SC 29472
(843) 821-9150
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1718
—
156FX1800X
Optician
Primary
717
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DV7172
—
SC
Enumeration date
09/18/2012
Last updated
09/19/2012
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