| |
2027 San Elijo Ave, Suite 2027, Cardiff, CA 92007-1726 | |
(760) 452-2895 | |
(760) 452-2898 |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 2027 San Elijo Ave, Cardiff, California |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
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1780954818 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 1154T (California) | Primary |
Provider Name | Michelle Kim |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1457328825 PECOS PAC ID: 7315962628 Enrollment ID: I20051005001244 |
Provider Name | Tania C Kaczanowski |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1356318901 PECOS PAC ID: 8729277256 Enrollment ID: I20110113000759 |
Mailing Address | Practice Location Address |
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2027 San Elijo Ave, Suite 2027, Cardiff, CA 92007-1726 Ph: (760) 452-2895 | 2027 San Elijo Ave, Suite 2027, Cardiff, CA 92007-1726 Ph: (760) 452-2895 |
Dr. Michelle Kim, OD Optometrist Medicare: Accepting Medicare Assignments Practice Location: 2027 San Elijo Ave Ste 2027, Cardiff, CA 92007 Phone: 760-452-2895 Fax: 760-452-2898 |