Diane M. Kim, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

270A00602800 Issued in NJ

Practice address

2151 Lemoine Ave.
Fort Lee, NJ 07024

Phone

(201) 346-9000

Fax

(201) 346-9001

NPI assigned

May 2, 2006

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 identifiers 2

Medicare fee-for-service enrollment

Enrolled in NJ

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

State University of New York - State College Optometry, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25246/brand/2/csg/1/fhir/r4

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.

• Fort Lee Vision LLC

  dba Fort Lee Vision

  • Eyewear Supplier
  • Fort Lee, NJ
  • NPI 1003144833
  Medicare reassignment NPD Authorized official
• Family Eye Clinic, Inc.

  • Optometrist
  • Palisades Park, NJ
  • NPI 1639301450
  NPD (past)
• Martin Sung Kim, O.D., Inc.

  • Optometrist
  • Palisades Park, NJ
  • NPI 1851337703
  NPD (past)
• Beechhurst Eye Associates

  • Optometrist
  • Whitestone, NY
  • NPI 1588742605
  NPD (past)
• State of New York Comptrollers Office

  dba Suny College of Optometry/University Eye Center

  • Optometrist
  • New York, NY
  • NPI 1407829856
  NPD (past)
• State of New York Comptrollers Office

  • Developmental Disabilities Clinic/Center
  • Staten Island, NY
  • NPI 1750469912
  NPD (past)

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418256000000",
    "number": "1710945589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2151 LEMOINE AVE.",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "07024",
            "telephone_number": "201-346-9000",
            "fax_number": "201-346-9001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 LEMOINE AVE.",
            "city": "FORT LEE",
            "state": "NJ",
            "postal_code": "07024",
            "telephone_number": "201-346-9000",
            "fax_number": "201-346-9001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "DIANE",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-02",
        "last_updated": "2014-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV006818",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "270A00602800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00244528",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0122874",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Annie Kim
• Byongyool Alan Kim, D.M.D
• Christian C Kim, M.D.
• Daniel Kim
• David Tae Kim, L.AC
• Doam Kim, L.AC.
• Dong Woong Kim, D.D.S
• Dongwoo Kim, LAC
• Eunice Y Kim
• Eunja Kim, M.D.

• Optometrist in Fort Lee, NJ
• Providers in Fort Lee, NJ by specialty
• Optometrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; 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.