Active NPI
Anderson Kim, O.D.
- Optometrist
- Jersey City, NJ
National Provider Identifier
1760832984
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 008417
- Practice address
- 30 Mall Dr W Ste 100
Jersey City, NJ 07310-1647 - Phone
- (201) 798-0303
- NPI assigned
- Jun 18, 2016
- Last updated
- Jul 10, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TUV008417-1 | NY | |
| Optometrist | 152W00000X | 008417 | NY | Primary |
Addresses
Primary practice location
30 Mall Dr W Ste 100
Jersey City, NJ 07310-1647
Mailing address
16 Cordelia CT
Buena Park, CA 90621-8436
Phone (562) 754-1721
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TUV008417-1 | NY | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Citilight Optometry, P.C. | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Optometrist
- Jersey City, NJ
- NPI 1366605289
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466208000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562716800000",
"number": "1760832984",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 CORDELIA CT",
"city": "BUENA PARK",
"state": "CA",
"postal_code": "906218436",
"telephone_number": "562-754-1721"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 MALL DR W STE 100",
"city": "JERSEY CITY",
"state": "NJ",
"postal_code": "073101647",
"telephone_number": "201-798-0303"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIM",
"first_name": "ANDERSON",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-06-18",
"last_updated": "2019-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "TUV008417-1",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NY",
"license": "008417",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jersey City, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.