Provider Demographics
NPI:1235311457
Name:LIMAGE, JEAN-ROBERT (OD)
Entity Type:Individual
Prefix:
First Name:JEAN-ROBERT
Middle Name:
Last Name:LIMAGE
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 1:355 W 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4817
Mailing Address - Country:US
Mailing Address - Phone:212-222-6770
Mailing Address - Fax:212-222-6770
Practice Address - Street 1:355 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4817
Practice Address - Country:US
Practice Address - Phone:212-222-6770
Practice Address - Fax:212-222-6770
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC006864-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC006864-1OtherLICENSE