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Kimberly S Theis

Optometrist

Eye and Vision Services Providers

PECOS Enrollment

This provider is enrolled in PECOS as KIMBERLY THEIS.

Based on the most recent information from CMS, provider Kimberly S Theis is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1871512731
Provider Type
Individual
Full Name
Theis, Kimberly S
Title
Dr.
Credential
O.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
7/19/2006
Last Updated
5/7/2015

Contact Information

Practice Location

3998 Powell Rd, Powell, OH 43065-7662

(614) 336-3727

Unlisted Fax

Mailing Location

4240 Scioto Pkwy, Powell, OH 43065-8075

(614) 517-7167

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 152W00000X Primary	Description Optometrist Eye and Vision Services Providers	License 5660 Ohio
Code 152W00000X	Description Optometrist Eye and Vision Services Providers	License 13027 California
Code 152W00000X	Description Optometrist Eye and Vision Services Providers	License 1295 Nebraska

Kimberly S Theis

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

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