Provider Demographics
NPI:1710301270
Name:LIM, SE
Entity Type:Individual
Prefix:
First Name:SE
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 E 17TH ST STE G
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8624
Mailing Address - Country:US
Mailing Address - Phone:714-543-9489
Mailing Address - Fax:714-543-1861
Practice Address - Street 1:1730 E 17TH ST STE G
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8624
Practice Address - Country:US
Practice Address - Phone:714-543-9489
Practice Address - Fax:714-543-1861
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14835152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist