Provider Demographics
NPI:1982042925
Name:LIN, JEFFERSON (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERSON
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070-72 BURNSVILLE CENTER
Mailing Address - Street 2:DRS. NORTH AND WATSON, OPTOMETRISTS P.A.
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2070-72 BURNSVILLE CENTER
Practice Address - Street 2:DRS. NORTH AND WATSON OPTOMETRISTS, P.A.
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306
Practice Address - Country:US
Practice Address - Phone:952-435-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008021152W00000X
MN3362152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist