Provider Demographics
NPI:1053302281
Name:LIMA, LOUIS MARTIN (OD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:MARTIN
Last Name:LIMA
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 1:13774 CALLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8579
Mailing Address - Country:US
Mailing Address - Phone:561-793-5556
Mailing Address - Fax:561-793-9817
Practice Address - Street 1:1050 SE MONTEREY RD
Practice Address - Street 2:#104
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4512
Practice Address - Country:US
Practice Address - Phone:772-282-2020
Practice Address - Fax:772-220-9582
Is Sole Proprietor?:No
Enumeration Date:2005-11-05
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2372152W00000X
TX4116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6201539Medicaid
FL6201539Medicaid
FLU13492Medicare UPIN