1770638348 NPI number — DR. JANE LIM O.D.

Table of content: DR. JANE LIM O.D. (NPI 1770638348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770638348 NPI number — DR. JANE LIM O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIM
Provider First Name:
JANE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PC
Provider Other First Name:
JL EYE ASSOCIATES,PC
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1770638348
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3990 ASHLAND DRIVE
Provider Second Line Business Mailing Address:
46 PO
Provider Business Mailing Address City Name:
SKIPPACK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19474-0046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-410-5290
Provider Business Mailing Address Fax Number:
610-584-0314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3990 ASHLAND DRIVE
Provider Second Line Business Practice Location Address:
46 PO
Provider Business Practice Location Address City Name:
SKIPPACK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19474-0046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-410-5290
Provider Business Practice Location Address Fax Number:
610-584-0314
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000061 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 09768 . This is a "MEDICARE PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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