Provider Demographics
NPI:1639862501
Name:LIN, LUKE LIVINGSTONE (OD)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:LIVINGSTONE
Last Name:LIN
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 1:11105 ICE SKATE PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4867
Mailing Address - Country:US
Mailing Address - Phone:858-848-4749
Mailing Address - Fax:
Practice Address - Street 1:7155 BROADWAY
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1408
Practice Address - Country:US
Practice Address - Phone:858-848-4749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist