Carol Kim, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD60188672 Issued in WA

Practice address

18700 Alderwood Mall Pkwy
Lynnwood, WA 98037-8005

Phone

(425) 640-6532

Fax

(425) 640-7518

NPI assigned

Jul 4, 2007

Last updated

Sep 26, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Carol Shim Former name

Medicare fee-for-service enrollment

Enrolled in WA

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

Southern California College of Optometry, 2007

Medicare assignment

May accept Medicare assignment

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Crystal Vision Care, PLLC

  • Optometrist
  • Lynnwood, WA
  • NPI 1639557952
  Medicare reassignment NPD Authorized official
• Esther L. Ahn Optometric Professional Corporation

  • Optometrist
  • Cerritos, CA
  • NPI 1740408822
  NPD (past)

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

{
    "created_epoch": "1183507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569456000000",
    "number": "1700084456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3829 177TH PL SW",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980377528",
            "telephone_number": "714-469-1478",
            "fax_number": "425-406-7518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18700 ALDERWOOD MALL PKWY",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980378005",
            "telephone_number": "425-640-6532",
            "fax_number": "425-640-7518"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1302 SE Everett Mall Way",
            "address_2": "Sears Optical",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982082831",
            "country_code": "US",
            "telephone_number": "714-469-1478",
            "fax_number": "425-348-5080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "CAROL",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-04",
        "last_updated": "2019-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "13281",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60188672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROL",
            "last_name": "SHIM",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Teresia Kibue
• Karl Joseph Kiggundu
• Kim & Chung, DDS, PLLC (Everyone By One-Lynnwood)
• Anna Kim
• Byungsung Kim, D.C.
• Casey Kwon Kim, MD
• Christopher H Kim, PHARM D
• Chul Kim
• Daniel Taeho Kim, D.C.
• David Ung Kim, M.D.

• Optometrist in Lynnwood, WA
• Providers in Lynnwood, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2019; 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.