Provider Demographics
NPI:1811912843
Name:KIM, ANDREW (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
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 1:2449 BOWLING GREEN WAY
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-4543
Mailing Address - Country:US
Mailing Address - Phone:850-471-7675
Mailing Address - Fax:850-471-7765
Practice Address - Street 1:2449 BOWLING GREEN WAY
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-4543
Practice Address - Country:US
Practice Address - Phone:850-471-7675
Practice Address - Fax:850-471-7765
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005661152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist