=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215126115
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENNIS LIN, O.D., INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2007
-----------------------------------------------------
Last Update Date | 08/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 537 S ATLANTIC BLVD
-----------------------------------------------------
City | MONTEREY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91754-3815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-264-2015
-----------------------------------------------------
Fax | 323-264-2025
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 537 S ATLANTIC BLVD
-----------------------------------------------------
City | MONTEREY PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91754-3815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-264-2015
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. DENNIS LIN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 323-264-2015
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 12326T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------