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General NPI Number Information
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NPI Number | 1487067559
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Entity Type | Individual
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Provider Name | RACHELLE JESSICA LIN O.D., M.S.
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Gender | Female
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 2575 YORBA LINDA BLVD
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City | FULLERTON
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State | CA
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Zip | 92831
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Country | US
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Telephone | 714-992-7890
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Fax |
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Provider Business Mailing Address
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Address Line | 2575 YORBA LINDA BLVD
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City | FULLERTON
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State | CA
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Zip | 92831
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Country | US
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Telephone | 714-992-7890
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 14859 TLG
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License Number State | CA
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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 | 14859TLG
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License Number State | CA
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