Healthcare Provider Details

I. General information

NPI: 1851588750
Provider Name (Legal Business Name): LEWIS S LIM AND ASSOCIATES OD PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10024 SE 240TH ST STE 220
KENT WA
98031-5124
US

IV. Provider business mailing address

10024 SE 240TH STE 220
KENT WA
98031-5124
US

V. Phone/Fax

Practice location:
  • Phone: 253-852-5440
  • Fax: 253-852-0272
Mailing address:
  • Phone: 253-852-5440
  • Fax: 253-852-0272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3736TX
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number3736TX
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number3736TX
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number3736TX
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number3736TX
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number3736TX
License Number StateWA
# 7
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3736TX
License Number StateWA

VIII. Authorized Official

Name: DR. LEWIS SENG LIM
Title or Position: OPTOMETRIST/PRESIDENT
Credential: O.D.
Phone: 253-852-5440