Provider Demographics
NPI:1093533804
Name:PAUL KIM OPTOMETRY VICTORVILLE A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:PAUL KIM OPTOMETRY VICTORVILLE A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-903-8988
Mailing Address - Street 1:14309 BEAR VALLEY RD STE 4
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-7648
Mailing Address - Country:US
Mailing Address - Phone:760-205-5901
Mailing Address - Fax:
Practice Address - Street 1:14309 BEAR VALLEY RD STE 4
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-7648
Practice Address - Country:US
Practice Address - Phone:760-205-5901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty