Healthcare Provider Details

I. General information

NPI: 1407868920
Provider Name (Legal Business Name): POLEN LIM O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 E ANAHEIM ST
LONG BEACH CA
90813-3507
US

IV. Provider business mailing address

1326 E 9TH ST
LONG BEACH CA
90813-4925
US

V. Phone/Fax

Practice location:
  • Phone: 562-591-7700
  • Fax:
Mailing address:
  • Phone: 562-591-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12694T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: