Ethan Yooseok Kim, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

RT009892 Issued in NY

Practice address

3925 Bell Blvd
Bayside, NY 11361-2060

Phone

(718) 279-2020

NPI assigned

Sep 8, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Optometry

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye and I Eyecare LLCGroup PAC ID 0749523108, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Eye & I Eyecare LLC

  • Optometrist
  • Bayside, NY
  • NPI 1992369623
  Medicare reassignment Care Compare group NPD
• Eye & I Eyecare LLC

  • Optometrist
  • Great Neck, NY
  • NPI 1669113627
  NPD

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

{
    "created_epoch": "1694131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694131200000",
    "number": "1124805684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4528 220TH PL",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113613647",
            "telephone_number": "929-369-7211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3925 BELL BLVD",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113612060",
            "telephone_number": "718-279-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "ETHAN",
        "middle_name": "YOOSEOK",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-09-08",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "RT009892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley E Kim
• Chang Sung Kim, D.C.
• Chong Min Kim, LAC
• Chongnam Kim, DDS
• David Kim, LAC.
• Eun Kyung Kim, L. AC.
• Eunae Christina Kim, PH.D.
• Hiyong Kim, D.D.S.
• Irene E Kim, NP
• Jason Kim

• Optometrist in Bayside, NY
• Providers in Bayside, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.