Provider Demographics
NPI:1407925811
Name:LIN, AMY S (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:S
Last Name:LIN
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 1:417 SYCAMORE VALLEY RD WEST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-3951
Mailing Address - Country:US
Mailing Address - Phone:925-838-3021
Mailing Address - Fax:206-426-7275
Practice Address - Street 1:1480 MORAGA RD
Practice Address - Street 2:SUITE I - 222
Practice Address - City:MORAGA
Practice Address - State:CA
Practice Address - Zip Code:94556-2005
Practice Address - Country:US
Practice Address - Phone:415-786-4521
Practice Address - Fax:206-426-7275
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11853T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist