Individual
KIMBERLY S MOLTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1008 BRIDGE ST, CHARLEVOIX, MI 49720-1602
(231) 547-7800
(231) 547-7874
Mailing address
PO BOX 2027, KALKASKA, MI 49646-2027
(231) 258-9781
(231) 258-0616
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003200
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0800300002
DMEPOS
MI
05
—
1891707584
—
MI
01
—
900AS10210
BLUE CROSS BLUE SHIELD
MI
01
—
KM003200
STATE LICENSE
MI
01
—
MI3200
EYEMED
MI
01
—
OPC2298
FLORIDA LICENSE NUMBER
FL
Enumeration date
08/12/2006
Last updated
01/07/2008
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