NPIMap

Organization Active NPI

Darran Kim O.D. PLLC

Doing business as Silver Lake Eye Care Center

  • Optometrist
  • Everett, WA
National Provider Identifier
1033891304
Registry record updated Aug 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
DARRAN KIM O.D. PLLC
Doing business as
Silver Lake Eye Care Center
Practice address
10101 19TH Ave SE Ste B
Everett, WA 98208-4255
Phone
(763) 762-3247
NPI assigned
Aug 4, 2023
Last updated
Aug 30, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Darran Kim, ODNPI 1629570908
Title
President/Authorized Official
Phone
(763) 762-3247

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary

Addresses

Primary practice location

10101 19TH Ave SE Ste B
Everett, WA 98208-4255

Mailing address

10101 19TH Ave SE Ste B
Everett, WA 98208-4255
Phone (763) 762-3247

Other names 1

  • Silver Lake Eye Care Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230925001747 WA Part B Supplier - Clinic/Group Practice 6507210572 Receives reassigned benefits from 4 practitioners
Practice locations: Everett, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1691107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693353600000",
    "number": "1033891304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10101 19TH AVE SE STE B",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982084255",
            "telephone_number": "763-762-3247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10101 19TH AVE SE STE B",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982084255",
            "telephone_number": "763-762-3247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DARRAN KIM O.D. PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-04",
        "last_updated": "2023-08-30",
        "certification_date": "2023-08-30",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "DARRAN",
        "authorized_official_title_or_position": "PRESIDENT/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "763-762-3247",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Silver Lake Eye Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.