Provider Demographics
NPI:1528178928
Name:KIM, WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6541
Mailing Address - Country:US
Mailing Address - Phone:678-926-3074
Mailing Address - Fax:678-606-1911
Practice Address - Street 1:3245 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6541
Practice Address - Country:US
Practice Address - Phone:678-926-3074
Practice Address - Fax:678-606-1911
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSA53TA638152W00000X
GAOPT002317152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL200891117OtherVISION CARE PLAN
AL51526667OtherALL KIDS
GAA03992OtherVCP
AL200891117OtherSPECTERA
AL200891117OtherSOUTHLAND
ALU97383OtherHEALTH SPRINGS
AL200891117OtherSUPERIOR VISION SEVICES
AL200891117OtherVIVA HEALTH
AL200891117OtherVISION SERVICE PLAN
AL529923760Medicaid
AL009996865Medicaid
GA27409OtherSPECTERA
AL5459930001OtherPALMETTO GBA
GAA03992OtherEYEMED
AL200891117OtherVIVA HEALTH