Provider Demographics
NPI:1932652179
Name:KIM EYE CENTER, PLLC
Entity Type:Organization
Organization Name:KIM EYE CENTER, PLLC
Other - Org Name:FOCUS VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPEUTIC OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:318-775-9834
Mailing Address - Street 1:701 E BLUFF ST APT 6105
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-2368
Mailing Address - Country:US
Mailing Address - Phone:318-775-9834
Mailing Address - Fax:
Practice Address - Street 1:1221 FM 1187 E
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-4370
Practice Address - Country:US
Practice Address - Phone:817-782-9972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-23
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8558TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1871992719Medicare UPIN