Provider Demographics
NPI:1104896372
Name:LIM, EDWARD LOUIE (OD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LOUIE
Last Name:LIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2109 FOREST AVE
Mailing Address - Street 2:SUITE 50
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-7680
Mailing Address - Country:US
Mailing Address - Phone:530-342-9644
Mailing Address - Fax:530-345-7547
Practice Address - Street 1:2109 FOREST AVE
Practice Address - Street 2:SUITE 50
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-7680
Practice Address - Country:US
Practice Address - Phone:530-342-9644
Practice Address - Fax:530-345-7547
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA06077T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA03557OtherMEDICAL EYE SERVICES ID #
CA38805OtherDAVIS VISION ID #
CASD0060770Medicaid
CA8830OtherSAFEGUARD ID #
CASD0060770Medicaid