Provider Demographics
NPI:1407868920
Name:LIM, POLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:POLEN
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4925
Mailing Address - Country:US
Mailing Address - Phone:562-591-7700
Mailing Address - Fax:
Practice Address - Street 1:709 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3507
Practice Address - Country:US
Practice Address - Phone:562-591-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12694T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12694TOtherLICENSE NUMBER
CASD0126940OtherMEDI-CAL PROVIDER NUMBER
CAW19256AMedicare ID - Type UnspecifiedGROUP ID
CAV07750Medicare UPIN
CA12694TOtherLICENSE NUMBER