Provider Demographics
NPI:1770710220
Name:EDWARD S LIM, MD, LLC
Entity type:Organization
Organization Name:EDWARD S LIM, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-643-0270
Mailing Address - Street 1:144 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3044
Mailing Address - Country:US
Mailing Address - Phone:203-643-0270
Mailing Address - Fax:203-488-1104
Practice Address - Street 1:144 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3044
Practice Address - Country:US
Practice Address - Phone:203-643-0270
Practice Address - Fax:203-488-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD100000268OtherMEDICARE PTAN
CT180034796OtherMC