Provider Demographics
NPI:1346525763
Name:JENNIFER LIN OD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JENNIFER LIN OD A PROFESSIONAL CORPORATION
Other - Org Name:WINK OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-501-2821
Mailing Address - Street 1:70 THROCKMORTON AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1918
Mailing Address - Country:US
Mailing Address - Phone:415-383-4085
Mailing Address - Fax:415-634-1364
Practice Address - Street 1:70 THROCKMORTON AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1918
Practice Address - Country:US
Practice Address - Phone:415-383-4085
Practice Address - Fax:415-634-1364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13969152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty