Provider Demographics
NPI:1932201878
Name:LALIM, KORRIE LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:KORRIE
Middle Name:LYNN
Last Name:LALIM
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 1:2050 W HWY 30A
Mailing Address - Street 2:ST 119
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-4359
Mailing Address - Country:US
Mailing Address - Phone:850-608-3135
Mailing Address - Fax:
Practice Address - Street 1:2050 W COUNTY HIGHWAY 30A
Practice Address - Street 2:STE 119
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-0187
Practice Address - Country:US
Practice Address - Phone:850-608-3135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-9380152W00000X
FLOPC 3910152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU91579Medicare UPIN