Provider Demographics
NPI:1619035151
Name:ADMIRE, KIM E (OD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:E
Last Name:ADMIRE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 BROADWAY
Mailing Address - Street 2:SUITE 1021
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5307
Mailing Address - Country:US
Mailing Address - Phone:619-427-6253
Mailing Address - Fax:619-427-4110
Practice Address - Street 1:555 BROADWAY
Practice Address - Street 2:SUITE 1021
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5307
Practice Address - Country:US
Practice Address - Phone:619-427-6253
Practice Address - Fax:619-427-4110
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 10752T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0107521Medicaid
CAU77640Medicare UPIN