Individual
MRS. KIMBERLY D FORNISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
5525 GEORGETOWN RD, SUITE J, INDIANAPOLIS, IN 46254-3724
(317) 297-1788
(317) 297-1790
Mailing address
5525 GEORGETOWN RD, SUITE J, INDIANAPOLIS, IN 46254-3724
(317) 297-1788
(317) 297-1790
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003112
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200512000
—
IN
Enumeration date
05/04/2006
Last updated
11/11/2008
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