Provider Demographics
NPI:1033891304
Name:DARRAN KIM O.D. PLLC
Entity Type:Organization
Organization Name:DARRAN KIM O.D. PLLC
Other - Org Name:SILVER LAKE EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DARRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:763-762-3247
Mailing Address - Street 1:10101 19TH AVE SE STE B
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4255
Mailing Address - Country:US
Mailing Address - Phone:763-762-3247
Mailing Address - Fax:
Practice Address - Street 1:10101 19TH AVE SE STE B
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4255
Practice Address - Country:US
Practice Address - Phone:763-762-3247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty