Provider Demographics
NPI:1578132254
Name:KIM, ALEX GIESOO (OD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:GIESOO
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 1:3025 112TH AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8002
Mailing Address - Country:US
Mailing Address - Phone:425-451-2020
Mailing Address - Fax:425-450-9696
Practice Address - Street 1:3025 112TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8002
Practice Address - Country:US
Practice Address - Phone:425-451-2020
Practice Address - Fax:425-450-9696
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003782152W00000X
WAOD61266420152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist