Provider Demographics
NPI:1457639239
Name:LIN, BETH E (OD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:E
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 1:29101 HEALTH CAMPUS DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5270
Mailing Address - Country:US
Mailing Address - Phone:440-835-6255
Mailing Address - Fax:440-899-4455
Practice Address - Street 1:29160 CENTER RIDGE RD STE G
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5265
Practice Address - Country:US
Practice Address - Phone:614-746-6339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6053152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0056007Medicaid
OHH034930Medicare PIN