Provider Demographics
NPI:1770638348
Name:LIM, JANE (OD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JL EYE ASSOCIATES,PC
Other - Middle Name:
Other - Last Name:PC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3990 ASHLAND DRIVE
Mailing Address - Street 2:46 PO
Mailing Address - City:SKIPPACK
Mailing Address - State:PA
Mailing Address - Zip Code:19474-0046
Mailing Address - Country:US
Mailing Address - Phone:610-410-5290
Mailing Address - Fax:610-584-0314
Practice Address - Street 1:3990 ASHLAND DRIVE
Practice Address - Street 2:46 PO
Practice Address - City:SKIPPACK
Practice Address - State:PA
Practice Address - Zip Code:19474-0046
Practice Address - Country:US
Practice Address - Phone:610-410-5290
Practice Address - Fax:610-584-0314
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA09768OtherMEDICARE PTAN
PA09768OtherMEDICARE PTAN
PA040040Medicare ID - Type UnspecifiedPROVIDER NUMBER
PAU-81195Medicare UPIN