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General NPI Number Information
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NPI Number | 1619035151
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Entity Type | Individual
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Provider Name | KIM E ADMIRE O.D.
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Gender | Female
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 555 BROADWAY SUITE 1021
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City | CHULA VISTA
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State | CA
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Zip | 91910-5307
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Country | US
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Telephone | 619-427-6253
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Fax | 619-427-4110
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Provider Business Mailing Address
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Address Line | 555 BROADWAY SUITE 1021
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City | CHULA VISTA
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State | CA
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Zip | 91910-5307
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Country | US
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Telephone | 619-427-6253
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Fax | 619-427-4110
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OPT 10752T
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License Number State | CA
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