Debbie Kim Edegran, O.D.
Individual provider Active NPI Optometrist · Closter, NJ
NPI 1487700431 · NPPES record last updated Dec 15, 2014
Key facts
- NPI
- 1487700431
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4813 (NJ)
- Practice address
- 520 Durie Ave
Closter, NJ 07624-2008 - Phone
- (201) 768-2020
- Fax
- (201) 768-5797
- NPI assigned
- Jan 25, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 1987
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sarah Y Kim OD LLC
Practice addresses (Care Compare)
520 Durie Ave
Closter, NJ 07624-2008
Phone (201) 768-2020
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090714000650 | NJ | Practitioner - Optometry | 4880746387 |
Reassigns benefits to 1 organization Practice locations: Closter, NJ |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4813 | NJ | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sarah Y. Kim, O.D. LLC | Optometrist | Current |
Accepting new patients |
| 9W Eyecare, LLC | Optometrist | Past | Accepting new patients |
| Debbie Kim | Optometrist | Past |
Accepting new patients |
Locations
520 Durie Ave
Closter, NJ 07624
Phone (201) 768-2020
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4813 | NJ | Yes |
Addresses
Primary practice location
520 Durie Ave
Closter, NJ 07624-2008
Mailing address
520 Durie Ave
Closter, NJ 07624-2008
Phone (201) 768-2020
Other names
- Dr. Debbie Kim
Other providers in Closter, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.