MEDICARE: DR. KORRIE LYNN LALIM O.D.

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	046-9380	IL
2	152W00000X	Optometrist	OPC 3910	FL

General Provider Information

NPI Number	:	1932201878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KORRIE LYNN LALIM O.D.

Provider Business Mailing Address
First Line	:	2050 W HWY 30A
Second Line	:	ST 119
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-4359
Country	:	US
Telephone Number	:	850-608-3135
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 W COUNTY HIGHWAY 30A
Second Line	:	STE 119
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-0187
Country	:	US
Telephone Number	:	850-608-3135
Fax Number	:

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

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	03/22/2016

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