Provider Demographics
NPI:1508085077
Name:KIM FAMILY EYECARE, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KIM FAMILY EYECARE, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-839-2202
Mailing Address - Street 1:404 LORELEI ROCK ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-3016
Mailing Address - Country:US
Mailing Address - Phone:702-839-2202
Mailing Address - Fax:702-839-2608
Practice Address - Street 1:8060 W TROPICAL PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4528
Practice Address - Country:US
Practice Address - Phone:702-839-2202
Practice Address - Fax:702-839-2608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV404152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty