Provider Demographics
NPI:1699873109
Name:HAUSER, KIMBERLY JANE (OD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JANE
Last Name:HAUSER
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 1:26731 CARRETAS DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5135
Mailing Address - Country:US
Mailing Address - Phone:949-584-7521
Mailing Address - Fax:
Practice Address - Street 1:2 JOURNEY STE 103
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3372
Practice Address - Country:US
Practice Address - Phone:949-362-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12196TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU93267Medicare UPIN