Provider Demographics
NPI:1760456248
Name:LIN, ROBERT T (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:T
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18725 GALE AVE
Mailing Address - Street 2:STE 140
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1354
Mailing Address - Country:US
Mailing Address - Phone:626-854-2020
Mailing Address - Fax:626-854-2021
Practice Address - Street 1:18725 GALE AVE
Practice Address - Street 2:STE 140
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1354
Practice Address - Country:US
Practice Address - Phone:626-854-2020
Practice Address - Fax:626-854-2021
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55952207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A559520Medicaid
CA954750920OtherTAX ID
CA00A559520Medicaid
CAA55952AMedicare PIN