Provider Demographics
NPI:1154761765
Name:KIM, HEATHER N (OD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:N
Last Name:KIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 COVEGLEN CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-6800
Mailing Address - Country:US
Mailing Address - Phone:719-500-1203
Mailing Address - Fax:
Practice Address - Street 1:3070 N POWERS BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-2803
Practice Address - Country:US
Practice Address - Phone:719-505-7334
Practice Address - Fax:719-505-7335
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2988152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist