Provider Demographics
NPI:1689670473
Name:EVEN, KIM B (OD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:B
Last Name:EVEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 FIRST AVE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-4033
Mailing Address - Country:US
Mailing Address - Phone:610-265-0765
Mailing Address - Fax:610-265-6824
Practice Address - Street 1:860 1ST AVE STE 1B
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4033
Practice Address - Country:US
Practice Address - Phone:610-265-0765
Practice Address - Fax:610-265-6824
Is Sole Proprietor?:No
Enumeration Date:2005-06-26
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000184152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA403479HMQMedicare ID - Type Unspecified