Provider Demographics
NPI:1851485866
Name:KIM, ANTHONY H (OD)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 WORLD COMMERCE PKWY
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3806
Mailing Address - Country:US
Mailing Address - Phone:904-687-1314
Mailing Address - Fax:
Practice Address - Street 1:215 WORLD COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3806
Practice Address - Country:US
Practice Address - Phone:904-687-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5288152W00000X
CAOPT12711T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V01047Medicare UPIN