MEDICARE: LIN YUAN CHIAO O.D. PROFESSIONAL CORPORATION

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	11867T	CA

General Provider Information

NPI Number	:	1992064430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIN YUAN CHIAO O.D. PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	5810 TEMPLE CITY BLVD
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-2112
Country	:	US
Telephone Number	:	626-287-9725
Fax Number	:

Provider Business Practice Location Address
First Line	:	5810 TEMPLE CITY BLVD
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780-2112
Country	:	US
Telephone Number	:	626-287-9725
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. LIN CHIAO
Credential	:
Telephone Number	:	626-287-9725

Provider Enumeration Date	:	05/03/2012
Last Update Date	:	01/27/2013

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