Provider Demographics
NPI:1265814305
Name:LY, HONG KIM (OD)
Entity Type:Individual
Prefix:DR
First Name:HONG
Middle Name:KIM
Last Name:LY
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 1:3331 MERIDIANA PARKWAY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3331 MERIDIANA PARKWAY
Practice Address - Street 2:SUITE 800
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583
Practice Address - Country:US
Practice Address - Phone:346-522-2015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8644T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist