Eyedream Eyecare, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT002343 Issued in GA

Legal business name

EYEDREAM EYECARE, LLC

Practice address

7774 McGinnis Ferry Rd
Suwanee, GA 30024-1622

Phone

(678) 540-4772

Fax

(678) 540-4752

NPI assigned

Dec 22, 2015

Organization subpart

No

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

Authorized official

Name

Maria M. Kim, O.DNPI 1184768715

Title

Optometrist/Owner

Phone

(678) 267-5843

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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.

• Maria Mikyung Kim, O.D.

  • Optometrist
  • Suwanee, GA
  • NPI 1184768715
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1450742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457049600000",
    "number": "1720443401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7774 MCGINNIS FERRY RD",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300241622",
            "telephone_number": "678-540-4772",
            "fax_number": "678-540-4752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7774 MCGINNIS FERRY RD",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300241622",
            "telephone_number": "678-540-4772",
            "fax_number": "678-540-4752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYEDREAM EYECARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-22",
        "last_updated": "2016-03-04",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "678-267-5843",
        "authorized_official_credential": "O.D"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Marie Ethridge
• Natoya Evans, M.A., B.C.B.A.
• Paul Evans, DO
• Evergreen Mobile Primary Care LLC
• Expectingeats LLC
• Eyelogic, LLC (EyeBelieve EyeCare & Optical)
• Eyez, Inc. (Suwanee Vision Center)
• Colleen Ann Eyre, OTR/L CLT LANA
• Clarice M Ezeanya, DPT
• Facial Trauma Specialists LLC

• Optometrist in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; 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.