Provider Demographics
NPI:1922156694
Name:KIM, ROY HYUNCHUL (OD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:HYUNCHUL
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 1:6534 ANTHONY DR
Mailing Address - Street 2:STE B
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1403
Mailing Address - Country:US
Mailing Address - Phone:585-398-7545
Mailing Address - Fax:585-398-7578
Practice Address - Street 1:6534 ANTHONY DR
Practice Address - Street 2:STE B
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1403
Practice Address - Country:US
Practice Address - Phone:585-398-7545
Practice Address - Fax:585-398-7578
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006892-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU53850Medicare UPIN