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General NPI Number Information
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NPI Number | 1407151178
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Entity Type | Organization
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Legal Business Name | LIN EYECARE INC
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Dates
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Enumeration Date | 01/11/2011
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 131 MARKHAM PL
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1400
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Country | US
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Telephone | 732-530-8610
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Fax |
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Provider Business Mailing Address
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Address Line | 131 MARKHAM PL
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1400
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Country | US
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Telephone | 732-530-8610
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | SUSAN LIN
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Credential | O.D.
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Telephone | 732-851-4996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | OA 5774
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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