Provider Demographics
NPI:1992936298
Name:CUNNINGHAM, KIMBERLY LAURA (OD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:LAURA
Last Name:CUNNINGHAM
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:PO BOX 201764
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-1764
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:
Practice Address - Street 1:955 W SOUTHERN AVE STE 122
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4903
Practice Address - Country:US
Practice Address - Phone:480-835-4440
Practice Address - Fax:480-835-8882
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1971152W00000X
CO2741152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist