Doo Yeon Kang, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT002744 Issued in GA

Practice address

206 Maple Dr
Vidalia, GA 30474

Phone

(912) 537-2020

Fax

(912) 537-7935

NPI assigned

Aug 31, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in GA

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

Other, 2012

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. 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.

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 and National Provider Directory roles.

• Vidalia Eyecare LLC

  • Optometrist
  • Vidalia, GA
  • NPI 1568936151
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1346371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547596800000",
    "number": "1902155393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 MAPLE DR",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304748907",
            "telephone_number": "912-537-2020",
            "fax_number": "912-537-7935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 MAPLE DR",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "30474",
            "telephone_number": "912-537-2020",
            "fax_number": "912-537-7935"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4720 Waters Avenue",
            "address_purpose": "LOCATION",
            "city": "Savannah",
            "state": "GA",
            "postal_code": "314046292",
            "country_code": "US",
            "telephone_number": "912-354-4800",
            "fax_number": "912-629-5815",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "104 Charles Andrews Drive, Suite 112",
            "address_purpose": "LOCATION",
            "city": "Vidalia",
            "state": "GA",
            "postal_code": "304743047",
            "country_code": "US",
            "telephone_number": "912-537-4447",
            "fax_number": "912-537-2743",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KANG",
        "first_name": "DOO",
        "middle_name": "YEON",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-31",
        "last_updated": "2019-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT002744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003135309B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003135309C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003135309A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer J Jones, FNP
• Hugh Frederick Jordan, D.D.S,
• Diedra Michelle Joseph Baker, MD
• Joseph G Foust MD LLC
• Amber Nobles Joyner, NP
• Keis Testing, LLC
• Kristen Keown
• Colleen Marie Kerrigan, PA
• Rick L Kimbrel I, D.M.D.
• Archie Thomas Kirkley, PA-C

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 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.