Healthcare Provider Details

I. General information

NPI: 1407151178
Provider Name (Legal Business Name): LIN EYECARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MARKHAM PL
LITTLE SILVER NJ
07739-1400
US

IV. Provider business mailing address

131 MARKHAM PL
LITTLE SILVER NJ
07739-1400
US

V. Phone/Fax

Practice location:
  • Phone: 732-530-8610
  • Fax:
Mailing address:
  • Phone: 732-530-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOA 5774
License Number StateNJ

VIII. Authorized Official

Name: SUSAN LIN
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 732-851-4996