Provider Demographics
NPI:1174691109
Name:KIMBALL, BRAD A (OD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:A
Last Name:KIMBALL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 LAKE ELMO DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-3066
Mailing Address - Country:US
Mailing Address - Phone:406-252-9927
Mailing Address - Fax:406-252-6567
Practice Address - Street 1:430 LAKE ELMO DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-3037
Practice Address - Country:US
Practice Address - Phone:406-252-9927
Practice Address - Fax:406-252-6567
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT480607Medicaid
MTP00180029OtherRAILROAD MEDICARE
MTU73098Medicare UPIN
MTP00180029OtherRAILROAD MEDICARE
MT0445350001Medicare NSC