Individual provider Active NPI

Seul Ki Lim, O.D.

  • Optometrist
  • Woodside, NY
National Provider Identifier
1093021321
Registry record updated Aug 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
007552 Issued in NY
Practice address
6909 Roosevelt Ave
Woodside, NY 11377-2933
Phone
(718) 639-1392
NPI assigned
Aug 24, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 007552 NY Primary

Addresses

Primary practice location

6909 Roosevelt Ave
Woodside, NY 11377-2933

Mailing address

6909 Roosevelt Ave
Woodside, NY 11377-2933
Phone (718) 639-1392

Other identifiers 1

IdentifierTypeStateIssuer
03289416MedicaidNY

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20120410000471 NY Practitioner - Optometry 3577724087 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 2010
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

6909 Roosevelt Ave
Woodside, NY 11377-2933
Phone (718) 639-1392

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
007552NYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eyellusion Vision Center Incorporated CurrentSince Apr 2, 2015 Accepting new patients
Eyellusion Vision Center Incorporated CurrentSince Apr 3, 2015 Accepting new patients

Locations

6909 Roosevelt Ave
Woodside, NY 11377
Phone (718) 639-1392

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1282608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408147200000",
    "number": "1093021321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6909 ROOSEVELT AVE",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113772933",
            "telephone_number": "718-639-1392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6909 ROOSEVELT AVE",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113772933",
            "telephone_number": "718-639-1392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIM",
        "first_name": "SEUL KI",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-24",
        "last_updated": "2014-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "007552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03289416",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodside, NY

Sources for this page

Verify at the official NPI Registry.