Individual
DR. DALE W KIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4575 LA JOLLA VILLAGE DR, SAN DIEGO, CA 92122-1203
(858) 453-4112
(858) 453-4398
Mailing address
4575 LA JOLLA VILLAGE DR, SAN DIEGO, CA 92122-1203
(858) 453-4112
(858) 453-4398
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
6064T
CA
152WC0802X
Corneal and Contact Management Optometrist
6064T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0060642
—
CA
Enumeration date
12/23/2006
Last updated
08/16/2010
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