Provider Demographics
NPI:1891682589
Name:KIM, ANNELISE UENMI (OD)
Entity type:Individual
Prefix:
First Name:ANNELISE
Middle Name:UENMI
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 1:504 TRAFFORD LN APT 504
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-5106
Mailing Address - Country:US
Mailing Address - Phone:912-704-1239
Mailing Address - Fax:
Practice Address - Street 1:4849 PAULSEN ST STE 312
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4426
Practice Address - Country:US
Practice Address - Phone:912-483-8817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GAOPT003678152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program