Fanette P. Kim O.D. PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

FANETTE P. KIM O.D. PLLC

Doing business as

Legacy Vision Care

Practice address

3604 Madaca LN
Tampa, FL 33618-2057

Phone

(850) 445-8171

NPI assigned

Dec 18, 2025

Organization subpart

No

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

Authorized official

Name

Dr. Fanette Kim, O.DNPI 1104132786

Title

Owner

Phone

(850) 445-8171

Specialties & licenses 1

Addresses

Other names 1

• Legacy Vision Care Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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.

• Fanette Kim, O.D.

  • Optometrist
  • Tampa, FL
  • NPI 1104132786
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1766016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766016000000",
    "number": "1154286490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 S LOIS AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336094320",
            "telephone_number": "850-445-8171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3604 MADACA LN",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336182057",
            "telephone_number": "850-445-8171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANETTE P. KIM O.D. PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-18",
        "last_updated": "2025-12-18",
        "certification_date": "2025-12-18",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "FANETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-445-8171",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Vision Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Yali Fan, D.O.M
• Nicole J Fanarjian, M.D.
• Karen M Fancher, PHARMD
• Fancy Feet Podiatry PA
• Danielle M Fanelle, MS, RD, CSR, LD
• Eugene Fanfan
• Jakaria Fanfan
• Francia Yuyan Fang
• Melinda Grace Fang, M.D.
• James Fanning, D.O.

• Optometrist in Tampa, FL
• Providers in Tampa, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2025; 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.