Provider Demographics
NPI:1104087907
Name:BARKER, KIMBERLY LAVIN (OD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LAVIN
Last Name:BARKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 FREEDOM PKWY STE C
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-4939
Practice Address - Country:US
Practice Address - Phone:919-545-0911
Practice Address - Fax:919-545-0096
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001695152W00000X
SC1497152W00000X
NC2091152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910692Medicaid
NCNC5867B130Medicare PIN