Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TUV008144 | NY |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | TUV008144 | NY |
N | 152WP0200X | Pediatric Optomitrist | TUV008144 | NY |
N | 152WV0400X | Optomitrist - Vision Therapist | TUV008144 | NY |
NPI | 1083013106 |
---|---|
Provider Name | Kimberly A Dobrodziej |
First Address | Ballston Spa, NY 12020-4404 |
Second Address | Saratoga Springs, NY 12866-2627 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2014 |
Last Update Date | 15/04/2020 |