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HALEY KIM OD
NPI 1104483833
Optometrist in Portland, OR

Active since May 29, 2019PECOS EnrolledAccepts Medicare Assignment
4880 NE 104TH AVE, PORTLAND, OR 97220(503) 432-8452(503) 432-8402 Get Directions Write a Review

NPPES record last updated: May 22, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jul 7, 2020, May 29, 2019 (2 updates tracked since 2019).

About Haley Kim Od NPPES

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

HALEY KIM OD (NPI 1104483833) is an individual optometrist in Portland, Oregon, licensed in Oregon (ATI4521) and active in the NPI registry since May 2019. She is enrolled in Medicare PECOS and is a graduate of Pacific University - College Of Optometry (2020).

NPPES Registry Identity

NPI1104483833
Entity TypeIndividualFemale
Primary Taxonomy152W00000X
Provider Legal NameHALEY KIMCredential: OD
Location Address4880 NE 104TH AVEPortland, OR 97220-3348
Mailing Address4880 Ne 104th AvePortland, OR 97220-3348 · (503) 432-8452 · Fax (503) 432-8402
Phone(503) 432-8452
Fax(503) 432-8402
Sole ProprietorNo
Medical School CMSPacific University - College Of OptometryGraduated 2020
Enumeration DateMay 29, 2019
Last NPPES UpdateMay 22, 20242 updates tracked since enumeration
NPPES CertifiedMay 22, 2024
✔ NPI 1104483833 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 OR · ATI4521
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.
4880 NE 104TH AVE, Portland, OR 97220
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Providence Health Plan, Regence BlueCross BlueShield of Oregon.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Haley Kim Od is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2769805688
PECOS Enrollment IDI20200710002722
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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97220 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
$134.16 typical visit price
range $58.99 – $176.88
Typical copayment $33.54 (range $14.74 – $44.22)
Most-billed visit code 99204
Established Patient
$73.28 typical visit price
range $19.32 – $144.79
Typical copayment $18.32 (range $4.83 – $36.19)
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.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PARKROSE VISION, LLC
Clinic/Center
4880 NE 104TH AVE
PORTLAND, OR 97220
Multnomah County (503) 943-0699

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 Haley Kim's NPI number?

The NPI number for Haley Kim is 1104483833. It was assigned to this individual provider in the NPPES registry on May 29, 2019.

Where is Haley Kim located?

Haley Kim practices at 4880 NE 104th Ave, Portland, OR 97220. The listed phone number is (503) 432-8452.

What is Haley Kim's specialty?

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

Is Haley Kim enrolled in Medicare?

Yes. Haley Kim is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Haley Kim accept?

Health plans from BridgeSpan Health Company, Providence Health Plan and Regence BlueCross BlueShield of Oregon list Haley 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 Haley Kim was last updated on May 22, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.