Provider Demographics
NPI:1033190491
Name:LIM, ANDREW RAYMOND (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RAYMOND
Last Name:LIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14905 PARAMOUNT BLVD
Mailing Address - Street 2:UNIT # E
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-3440
Mailing Address - Country:US
Mailing Address - Phone:562-633-6046
Mailing Address - Fax:
Practice Address - Street 1:14905 PARAMOUNT BLVD
Practice Address - Street 2:# E
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-3440
Practice Address - Country:US
Practice Address - Phone:562-633-6046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8777T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT72086Medicare UPIN
OP8777Medicare ID - Type Unspecified