MEDICARE: BERRYESSA OPTOMETRY, A PROFESSIONAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	10434T	CA

General Provider Information

NPI Number	:	1588632863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERRYESSA OPTOMETRY, A PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	2534 BERRYESSA RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2903
Country	:	US
Telephone Number	:	408-272-7200
Fax Number	:	408-272-3310

Provider Business Practice Location Address
First Line	:	2534 BERRYESSA RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-2903
Country	:	US
Telephone Number	:	408-272-7200
Fax Number	:	408-272-3310

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. THOMAS L LIM
Credential	:	O.D.
Telephone Number	:	408-272-7200

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	01/22/2013

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