Healthcare Provider Details

I. General information

NPI: 1053302281
Provider Name (Legal Business Name): LOUIS MARTIN LIMA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2005
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SE MONTEREY RD #104
STUART FL
34994-4512
US

IV. Provider business mailing address

13774 CALLINGTON DR
WELLINGTON FL
33414-8579
US

V. Phone/Fax

Practice location:
  • Phone: 772-282-2020
  • Fax: 772-220-9582
Mailing address:
  • Phone: 561-793-5556
  • Fax: 561-793-9817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 2372
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4116
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: