Provider Demographics
NPI:1588632863
Name:BERRYESSA OPTOMETRY, A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:BERRYESSA OPTOMETRY, A PROFESSIONAL CORP
Other - Org Name:TOMMY L. LIM, O.D., D.B.A.BERRYESSA OPTOMETRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:408-272-7200
Mailing Address - Street 1:2534 BERRYESSA RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2903
Mailing Address - Country:US
Mailing Address - Phone:408-272-7200
Mailing Address - Fax:408-272-3310
Practice Address - Street 1:2534 BERRYESSA RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2903
Practice Address - Country:US
Practice Address - Phone:408-272-7200
Practice Address - Fax:408-272-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10434T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10282Medicare ID - Type Unspecified
CAT10282Medicare UPIN