Provider Demographics
NPI:1093491193
Name:LIN, ANGELA MAYANN (OD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MAYANN
Last Name:LIN
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 1:10341 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3870
Mailing Address - Country:US
Mailing Address - Phone:408-515-6778
Mailing Address - Fax:
Practice Address - Street 1:10341 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3870
Practice Address - Country:US
Practice Address - Phone:408-515-6778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.007182152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist