Christa Kim OD and Associates PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

6015TG Issued in TX

Legal business name

CHRISTA KIM OD AND ASSOCIATES PC

Doing business as

Custom Eyes Optique and Eyecare

Practice address

2339 Round Mountain Cir
Lewisville, TX 75056-5633

Phone

(214) 387-7770

Fax

(214) 436-4488

NPI assigned

Oct 29, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Christa Y Kim, ODNPI 1417117227

Title

Optometrist

Phone

(214) 387-7770

Specialties & licenses 1

Addresses

Other names 1

• Custom Eyes Optique and Eyecare Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

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.

• Christa Yong Eun Kim, OD

  • Optometrist
  • Lewisville, TX
  • NPI 1417117227
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1225238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231804800000",
    "number": "1396998704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2339 ROUND MOUNTAIN CIR",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750565633",
            "telephone_number": "847-922-3281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2339 ROUND MOUNTAIN CIR",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750565633",
            "telephone_number": "214-387-7770",
            "fax_number": "214-436-4488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRISTA KIM OD AND ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-29",
        "last_updated": "2009-01-13",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "CHRISTA",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "214-387-7770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "TX",
            "license": "6015TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Eyes Optique and Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2009; 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.