Healthcare Provider Details

I. General information

NPI: 1689670473
Provider Name (Legal Business Name): KIM B. EVEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2005
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 1ST AVE STE 1B
KING OF PRUSSIA PA
19406-4033
US

IV. Provider business mailing address

860 FIRST AVE SUITE 1B
KING OF PRUSSIA PA
19406-4033
US

V. Phone/Fax

Practice location:
  • Phone: 610-265-0765
  • Fax: 610-265-6824
Mailing address:
  • Phone: 610-265-0765
  • Fax: 610-265-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000184
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: