Provider Demographics
NPI:1851485866
Name:KIM, ANTHONY H (OD)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1011 BUCKHORN BND
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3730 CARMIA DR SW
Practice Address - Street 2:SUITE 310
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-6251
Practice Address - Country:US
Practice Address - Phone:404-344-4136
Practice Address - Fax:404-346-7140
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002290152W00000X
CAOPT12711T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V01047Medicare UPIN