Provider Demographics
NPI:1538308655
Name:KIM'S EYELAND OPTICAL, INC.
Entity Type:Organization
Organization Name:KIM'S EYELAND OPTICAL, INC.
Other - Org Name:EYELAND OPTICAL, INC,
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHOON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:678-473-0911
Mailing Address - Street 1:3751 SATELLITE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8840
Mailing Address - Country:US
Mailing Address - Phone:678-473-0911
Mailing Address - Fax:678-473-9100
Practice Address - Street 1:3751 SATELLITE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8840
Practice Address - Country:US
Practice Address - Phone:678-473-0911
Practice Address - Fax:678-473-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA002284152W00000X
GALDO001889156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty