Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ethan Yooseok Kim, OD

Individual provider Optometrist · NPI 1124805684

Ethan Yooseok Kim, OD is an Optometry in Bayside, New York. Qualified in 2023, 3 years ago. Practices with Eye and I Eyecare LLC, a 3-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
3
Licensed in
NY
In the registry since
2023
What do these letters mean?
OD — Doctor of Optometry
An optometrist: examines eyes, prescribes glasses and contacts, and treats many eye conditions.

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Practice location Address checks out

3925 Bell Blvd
Bayside, NY 11361-2060
Phone: (718) 279-2020
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Optometrist (primary) Taxonomy 152W00000X · Licence RT009892 (NY)

Record details

NPI number1124805684
Entity typeIndividual (Type 1)
GenderMale
Credentials OD
Sole proprietorYes
NPI enumeratedSeptember 8, 2023
Last updated in NPPESSeptember 8, 2023
Certification dateSeptember 7, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOPTOMETRY
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Eye And I Eyecare Llc — 3 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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