Provider Demographics
NPI:1962491266
Name:LIM, RALPH REAGAN JR (DO)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:REAGAN
Last Name:LIM
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:210 N 7TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2244
Practice Address - Country:US
Practice Address - Phone:740-376-5590
Practice Address - Fax:740-376-5591
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34.006946207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2949420Medicaid
OHP01702083OtherRAILROAD MEDICARE - MHCPI
KYP00725741OtherRAILROAD MEDICARE
OHP00748930OtherRAILROAD MEDICARE
OHH403842Medicare PIN
OHH403841Medicare PIN
OH4264313Medicare PIN
OH4264311Medicare PIN
KYP00725741OtherRAILROAD MEDICARE
OH4264312Medicare PIN
OH4264314Medicare PIN