Provider Demographics
NPI:1770636896
Name:LIN, ALICE HUAICHING (OD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:HUAICHING
Last Name:LIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39055 CEDAR BLVD STE 133
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-5009
Mailing Address - Country:US
Mailing Address - Phone:510-795-0888
Mailing Address - Fax:510-795-0809
Practice Address - Street 1:39055 CEDAR BLVD STE 133
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-5009
Practice Address - Country:US
Practice Address - Phone:510-795-0888
Practice Address - Fax:510-795-0809
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 11009T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5702933OtherMEDI-CAL PIN #
CASDO 110090Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
CA5702933OtherMEDI-CAL PIN #