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DR. FANETTE KIM O.D.
NPI 1104132786
Optometrist in Tampa, FL

Active since August 20, 2010PECOS Enrolled
11921 N DALE MABRY HWY, TAMPA, FL 33609(813) 963-1008 Get Directions Write a Review

NPPES record last updated: November 25, 2015. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Dr. Fanette Kim O.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. FANETTE KIM O.D. (NPI 1104132786) is an individual optometrist in Tampa, Florida, licensed in Florida (OPC4519) and active in the NPI registry since August 2010. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104132786
Entity TypeIndividualFemale
Primary Taxonomy152W00000X
Provider Legal NameDR. FANETTE KIMCredential: O.D.
Location Address11921 N DALE MABRY HWYTampa, FL 33609
Mailing Address11921 N Dale Mabry HwyTampa, FL 33609 · (813) 963-1008
Phone(813) 963-1008
Sole ProprietorYes
Enumeration DateAugust 20, 2010
Last NPPES UpdateNovember 25, 2015
✔ NPI 1104132786 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License✔ Licensed in FL · OPC4519
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
11921 N DALE MABRY HWY, Tampa, FL 33609
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Fanette Kim O.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Fanette Kim reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Fanette P. Kim O.D. PLLC
10.0 mi
Optometrist
3604 MADACA LN
Tampa, FL 33618
  • Reassigned Medicare billing, Florida enrollment
NPI 1154286490 (850) 445-8171

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33609 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$130.04 typical visit price
range $56.00 – $171.84
Typical copayment $32.51 (range $14.00 – $42.96)
Most-billed visit code 99204
Established Patient
$70.04 typical visit price
range $17.57 – $139.16
Typical copayment $17.51 (range $4.39 – $34.79)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fanette Kim's NPI number?

The NPI number for Fanette Kim is 1104132786. It was assigned to this individual provider in the NPPES registry on August 20, 2010.

Where is Fanette Kim located?

Fanette Kim practices at 11921 N Dale Mabry Hwy, Tampa, FL 33609. The listed phone number is (813) 963-1008.

What is Fanette Kim's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Fanette Kim enrolled in Medicare?

Yes. Fanette Kim is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Fanette Kim's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Fanette Kim reassigns Medicare benefits to Fanette P. Kim O.D. PLLC (Tampa, FL). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Fanette Kim's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Fanette Kim accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Oscar Health Insurance and 7 other insurers list Fanette Kim as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Fanette Kim was last updated on November 25, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.