MEDICARE: GREGORY LIN

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	0618002660	VA

General Provider Information

NPI Number	:	1902390511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY LIN

Provider Business Mailing Address
First Line	:	4 FAIR OAKS AVE
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02460-1217
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5503 LEESBURG PIKE
Second Line	:
City	:	BAILEYS CROSSROADS
State	:	VA
Zip	:	22041-3109
Country	:	US
Telephone Number	:	571-483-4021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	06/18/2018

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Directions to “ GREGORY LIN ” Practice Location

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