MEDICARE: BARNIE Y LIM O.D.

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	007523	NY
2	152W00000X	Optometrist	12501T	CA

General Provider Information

NPI Number	:	1790709418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARNIE Y LIM O.D.

Provider Business Mailing Address
First Line	:	3841 BRICKWAY BLVD
Second Line	:	SANTA ROSA VA CBOC EYE CLINIC
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-8226
Country	:	US
Telephone Number	:	707-569-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3841 BRICKWAY BLVD
Second Line	:	SANTA ROSA VA CBOC EYE CLINIC
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-8226
Country	:	US
Telephone Number	:	707-569-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	05/25/2015

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