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General NPI Number Information
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NPI Number | 1932652179
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Entity Type | Organization
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Legal Business Name | KIM EYE CENTER, PLLC
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Dates
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Enumeration Date | 07/23/2016
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 1221 FM 1187 E
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City | CROWLEY
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State | TX
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Zip | 76036-4370
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Country | US
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Telephone | 817-782-9972
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Fax |
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Provider Business Mailing Address
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Address Line | 701 E BLUFF ST APT 6105
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City | FORT WORTH
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State | TX
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Zip | 76102-2368
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Country | US
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Telephone | 318-775-9834
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Fax |
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Authorized Official
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Title or Position | THERAPEUTIC OPTOMETRIST
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Name | AGNES KIM
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Credential | O.D.
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Telephone | 318-775-9834
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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 | 8558TG
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License Number State | TX
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