Provider Demographics
NPI:1033424791
Name:MIN, ELEANOR KIM (OD)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:KIM
Last Name:MIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ELEANOR
Other - Middle Name:K
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1209 YORK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6220
Mailing Address - Country:US
Mailing Address - Phone:410-821-9490
Mailing Address - Fax:410-821-9495
Practice Address - Street 1:1209 YORK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6220
Practice Address - Country:US
Practice Address - Phone:410-821-9490
Practice Address - Fax:410-821-9495
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2300152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics