Tae Won Kim, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

9128 Issued in TX

Practice address

2100 S W S Young Dr Ste 1000
Killeen, TX 76543-5355

Phone

(254) 261-7449

Fax

(254) 261-7450

NPI assigned

Aug 21, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jennifer C. Pacheco, O.D., P.L.L.C.

  • Optometrist
  • Pompano Beach, FL
  • NPI 1417376112
  Medicare reassignment NPD
• Killeen Vision 153

  • Corneal and Contact Management Optometrist
  • Killeen, TX
  • NPI 1801586656
  NPD Authorized official

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

{
    "created_epoch": "1377043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684195200000",
    "number": "1073946406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 S W S YOUNG DR STE A",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765435352",
            "telephone_number": "254-953-1164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 S W S YOUNG DR STE 1000",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765435355",
            "telephone_number": "254-261-7449",
            "fax_number": "254-261-7450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 E Central Texas Expy Ste 300",
            "address_purpose": "LOCATION",
            "city": "Harker Heights",
            "state": "TX",
            "postal_code": "765482747",
            "country_code": "US",
            "telephone_number": "254-669-6316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "TAE WON",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-21",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC4831",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "9128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Killeen Neurology, PA
• Killeen Pediatric Care Clinic, P.a.
• Killeen Pharmacy
• Killeen Surgical Operating Company, LLC
• Killeen Vision 153
• Amanda Rose Kimball
• Dominique Kimble, NP
• Lindsey Grace Julliette Kimbrough, RD/RDN, LD
• Leonard J Kinateder, DDS
• Kenneth Richard Kindle, D.O.

• Optometrist in Killeen, TX
• Providers in Killeen, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.