Provider Demographics
NPI:1417012014
Name:STARNES-PARR, KIMBERLY RENEE (OD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RENEE
Last Name:STARNES-PARR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:RENEE
Other - Last Name:PARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:140 N MARKET ST
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-0820
Mailing Address - Country:US
Mailing Address - Phone:970-565-2020
Mailing Address - Fax:970-565-3632
Practice Address - Street 1:140 N MARKET ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-0820
Practice Address - Country:US
Practice Address - Phone:970-565-2020
Practice Address - Fax:970-565-3632
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2046152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO26959771Medicaid
COU82893Medicare UPIN
COF6723Medicare ID - Type Unspecified
CO0779800001Medicare NSC
CO26959771Medicaid