Healthcare Provider Details

I. General information

NPI: 1538385968
Provider Name (Legal Business Name): SUSAN LIN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN LIM O.D.

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 11/30/2018
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: 732-851-4996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOA5774
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOA 5774
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: