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General NPI Number Information
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NPI Number | 1154286490
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Entity Type | Organization
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Legal Business Name | FANETTE P. KIM O.D. PLLC
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Dates
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Enumeration Date | 12/18/2025
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 3604 MADACA LN
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City | TAMPA
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State | FL
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Zip | 33618-2057
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Country | US
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Telephone | 850-445-8171
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Fax |
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Provider Business Mailing Address
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Address Line | 705 S LOIS AVE
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City | TAMPA
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State | FL
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Zip | 33609-4320
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Country | US
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Telephone | 850-445-8171
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. FANETTE KIM
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Credential | O.D
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Telephone | 850-445-8171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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