Provider Demographics
NPI:1003969650
Name:YIM, TERESA ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANN
Last Name:YIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4454
Mailing Address - Country:US
Mailing Address - Phone:925-447-3883
Mailing Address - Fax:925-447-2957
Practice Address - Street 1:1800 4TH ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4454
Practice Address - Country:US
Practice Address - Phone:925-447-3883
Practice Address - Fax:925-447-2957
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7953T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0079530Medicaid
CASD0079530Medicaid
CAMY0648470OtherDEA REGISTRATION NUMBER