Healthcare Provider Details

I. General information

NPI: 1003969650
Provider Name (Legal Business Name): TERESA ANN YIM O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 4TH ST
LIVERMORE CA
94550-4454
US

IV. Provider business mailing address

1800 4TH ST
LIVERMORE CA
94550-4454
US

V. Phone/Fax

Practice location:
  • Phone: 925-447-3883
  • Fax: 925-447-2957
Mailing address:
  • Phone: 925-447-3883
  • Fax: 925-447-2957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number7953T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: