Provider Demographics
NPI:1568541407
Name:LIM, JOAQUIN VELOSO (OD)
Entity Type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:VELOSO
Last Name:LIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13545 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-4205
Mailing Address - Country:US
Mailing Address - Phone:216-451-4400
Mailing Address - Fax:216-451-1424
Practice Address - Street 1:13545 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-4205
Practice Address - Country:US
Practice Address - Phone:216-451-4400
Practice Address - Fax:216-451-1424
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4120/T1088152W00000X
AZ1432/P749A152W00000X
OH4120152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0769379Medicaid
OH34-1683051026Medicaid
OHU31471Medicare UPIN
OH0716101Medicare ID - Type Unspecified
OH34-1683051026Medicaid