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General NPI Number Information
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NPI Number | 1871767129
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Entity Type | Organization
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Legal Business Name | KIMS EYELAND OPTICAL, INC.
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 3751 SATELLITE BLVD SUITE 200
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City | DULUTH
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State | GA
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Zip | 30096-8840
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Country | US
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Telephone | 678-473-0911
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Fax | 678-473-9100
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Provider Business Mailing Address
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Address Line | 3751 SATELLITE BLVD SUITE 200
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City | DULUTH
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State | GA
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Zip | 30096-8840
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Country | US
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Telephone | 678-473-0911
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Fax | 678-473-9100
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHOON K KIM
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Credential |
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Telephone | 678-473-0911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | LDO1889
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License Number State | GA
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