=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992064430
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIN YUAN CHIAO O.D. PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2012
-----------------------------------------------------
Last Update Date | 01/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5810 TEMPLE CITY BLVD
-----------------------------------------------------
City | TEMPLE CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91780-2112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-287-9725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5810 TEMPLE CITY BLVD
-----------------------------------------------------
City | TEMPLE CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91780-2112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-287-9725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. LIN CHIAO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 626-287-9725
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 11867T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------