Healthcare Provider Details

I. General information

NPI: 1417235318
Provider Name (Legal Business Name): HANNA LYDIA KIM O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1128 DUFF AVE
AMES IA
50010-5776
US

IV. Provider business mailing address

1215 DUFF AVE
AMES IA
50010-5469
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-4460
  • Fax: 515-956-4145
Mailing address:
  • Phone: 515-239-4418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV007814
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number085121
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: