MEDICARE: KIM-OANH TON O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC4982	FL

General Provider Information

NPI Number	:	1770982704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM-OANH TON O.D.

Provider Business Mailing Address
First Line	:	5727 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5727 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6326
Country	:	US
Telephone Number	:	954-962-9994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2014
Last Update Date	:	01/06/2015

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