1851588750 NPI number — LEWIS S LIM AND ASSOCIATES OD PS

Table of content: (NPI 1851588750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851588750 NPI number — LEWIS S LIM AND ASSOCIATES OD PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEWIS S LIM AND ASSOCIATES OD PS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851588750
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10024 SE 240TH
Provider Second Line Business Mailing Address:
STE 220
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98031-5124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-852-5440
Provider Business Mailing Address Fax Number:
253-852-0272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10024 SE 240TH ST
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
KENT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98031-5124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-852-5440
Provider Business Practice Location Address Fax Number:
253-852-0272
Provider Enumeration Date:
09/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LIM
Authorized Official First Name:
LEWIS
Authorized Official Middle Name:
SENG
Authorized Official Title or Position:
OPTOMETRIST/PRESIDENT
Authorized Official Telephone Number:
253-852-5440

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3736TX , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: 3736TX , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WL0500X , with the licence number: 3736TX , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , with the licence number: 3736TX , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WS0006X , with the licence number: 3736TX , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WV0400X , with the licence number: 3736TX , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WX0102X , with the licence number: 3736TX , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2017499 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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