Provider Demographics
NPI:1396193629
Name:DR. IRENE M. LIN-DILORINZO, O.D., INC.
Entity Type:Organization
Organization Name:DR. IRENE M. LIN-DILORINZO, O.D., INC.
Other - Org Name:MONARCH BAY OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LIN-DILORINZO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-487-3937
Mailing Address - Street 1:32932 PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 13
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3466
Mailing Address - Country:US
Mailing Address - Phone:949-487-3937
Mailing Address - Fax:949-487-3913
Practice Address - Street 1:32932 PACIFIC COAST HWY
Practice Address - Street 2:SUITE 13
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3466
Practice Address - Country:US
Practice Address - Phone:949-487-3937
Practice Address - Fax:949-487-3913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9909T152W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0099090Medicaid
CASD0099090Medicaid