Provider Demographics
NPI:1073676409
Name:LIM, SEOKJAE D (OD)
Entity Type:Individual
Prefix:DR
First Name:SEOKJAE
Middle Name:D
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 1:7 ALFRED PL
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1050
Mailing Address - Country:US
Mailing Address - Phone:917-635-6897
Mailing Address - Fax:
Practice Address - Street 1:300 ROUTE 17 NORTH
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-2102
Practice Address - Country:US
Practice Address - Phone:201-438-3031
Practice Address - Fax:201-438-2483
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00597500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV02512Medicare UPIN
NJ094795Medicare ID - Type Unspecified