Provider Demographics
NPI:1356470058
Name:LIM, GERALDINE ANN
Entity Type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:ANN
Last Name:LIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 BERYL ST
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91737-2112
Mailing Address - Country:US
Mailing Address - Phone:909-899-0245
Mailing Address - Fax:909-899-1293
Practice Address - Street 1:8227 DAY CREEK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91739-8567
Practice Address - Country:US
Practice Address - Phone:909-899-0245
Practice Address - Fax:909-899-1293
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9485T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist