Provider Demographics
NPI:1194987628
Name:LIM, MIRA (MD)
Entity type:Individual
Prefix:DR
First Name:MIRA
Middle Name:
Last Name:LIM
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Gender:F
Credentials:MD
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Mailing Address - Street 1:365 LENNON LN
Mailing Address - Street 2:STE 210
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5912
Mailing Address - Country:US
Mailing Address - Phone:925-947-0888
Mailing Address - Fax:925-947-4385
Practice Address - Street 1:365 LENNON LN
Practice Address - Street 2:STE 210
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-5912
Practice Address - Country:US
Practice Address - Phone:925-947-0888
Practice Address - Fax:925-947-4385
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2020-04-28
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Provider Licenses
StateLicense IDTaxonomies
MA235486207W00000X
CAA108588207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology