Individual
MRS. KIMBERLY R BRISTOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1 CENTURIAN DR, SUITE 114, NEWARK, DE 19713-2137
(302) 993-0722
(302) 993-0754
Mailing address
103 CHESAPEAKE BLVD, STE C, ELKTON, MD 21921
(410) 392-4976
(410) 392-4958
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
13-0001241
DE
152W00000X
Optometrist
TA1463
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000542402
—
DE
05
—
116251900
—
MD
Enumeration date
05/03/2006
Last updated
09/22/2011
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