MEDICARE: WALTER YIM OD A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	12675 TLG	CA

General Provider Information

NPI Number	:	1336486729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTER YIM OD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	16450 BOLSA CHICA ST
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-2603
Country	:	US
Telephone Number	:	714-840-1366
Fax Number	:	714-846-9415

Provider Business Practice Location Address
First Line	:	16450 BOLSA CHICA ST
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-2603
Country	:	US
Telephone Number	:	714-840-1366
Fax Number	:	714-846-9415

Authorized Official
Title or Position	:	CEO
Name	:	DR. WALTER YIM
Credential	:	O.D.
Telephone Number	:	714-840-1366

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	03/18/2014

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