FANETTE P. KIM O.D. PLLC
NPI 1154286490
Optometrist in Tampa, FL

Q: What is Fanette P. Kim O.D. PLLC's NPI number?

The NPI number for Fanette P. Kim O.D. PLLC is 1154286490. It was assigned to this organization in the NPPES registry on December 18, 2025. The provider is doing business as Legacy Vision Care.

Q: What is Fanette P. Kim O.D. PLLC's specialty?

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

Active since December 18, 2025

3604 MADACA LN, TAMPA, FL 33618(850) 445-8171 Get Directions Write a Review

NPPES record last updated: December 18, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

On this page

About Fanette P. Kim O.d. Pllc NPPES

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

FANETTE P. KIM O.D. PLLC (NPI 1154286490), doing business as Legacy Vision Care, is a healthcare organization registered as an optometrist in Tampa, Florida and active in the NPI registry since December 2025. The organization lists Fanette Kim, Owner, as its authorized official.

NPPES Registry Identity

NPI1154286490

Entity TypeOrganization

Primary Taxonomy152W00000X

Legal Business NameFANETTE P. KIM O.D. PLLC

Location Address3604 MADACA LNTampa, FL 33618-2057

Mailing Address705 S Lois AveTampa, FL 33609-4320 · (850) 445-8171

Phone(850) 445-8171

Organization SubpartNo

Authorized OfficialFanette KimOwner · (850) 445-8171

Enumeration DateDecember 18, 2025

NPPES CertifiedDecember 18, 2025

✔ NPI 1154286490 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers

Taxonomy Code152W00000X

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.

3604 MADACA LN, Tampa, FL 33618

Open in Google Maps ↗

Other Names 1

Doing Business AsLegacy Vision Care

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Fanette P. Kim O.D. PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Fanette Kim, O.D.

Optometry

NPI 1104132786

11921 N DALE MABRY HWY
Tampa, FL 33609

(813) 963-1008

✔ PECOS10.0 mi

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

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 P. Kim O.D. PLLC's NPI number?

The NPI number for Fanette P. Kim O.D. PLLC is 1154286490. It was assigned to this organization in the NPPES registry on December 18, 2025. The provider is doing business as Legacy Vision Care.

Where is Fanette P. Kim O.D. PLLC located?

Fanette P. Kim O.D. PLLC is located at 3604 Madaca Ln, Tampa, FL 33618. The listed phone number is (850) 445-8171.

What is Fanette P. Kim O.D. PLLC's specialty?

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

Is Fanette P. Kim O.D. PLLC enrolled in Medicare?

Yes. Fanette P. Kim O.D. PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Fanette P. Kim O.D. PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Optometry) reassigns their Medicare billing to Fanette P. Kim O.D. PLLC. A 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 the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Fanette P. Kim O.D. PLLC was last updated on December 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months 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.