Provider Demographics
NPI:1336486729
Name:WALTER YIM OD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:WALTER YIM OD A PROFESSIONAL CORPORATION
Other - Org Name:PACIFIC EYE CARE, DOCTORS OF OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:YIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-840-1366
Mailing Address - Street 1:16450 BOLSA CHICA ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-2603
Mailing Address - Country:US
Mailing Address - Phone:714-840-1366
Mailing Address - Fax:714-846-9415
Practice Address - Street 1:16450 BOLSA CHICA ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-2603
Practice Address - Country:US
Practice Address - Phone:714-840-1366
Practice Address - Fax:714-846-9415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12675 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB207228Medicare PIN