Provider Demographics
NPI:1962491266
Name:LIM, RALPH REAGAN JR (DO)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:REAGAN
Last Name:LIM
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N JAMES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1834
Mailing Address - Country:US
Mailing Address - Phone:614-257-5642
Mailing Address - Fax:614-257-5288
Practice Address - Street 1:420 N JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1834
Practice Address - Country:US
Practice Address - Phone:142-575-6426
Practice Address - Fax:614-257-5288
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.006946207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00748930OtherRAILROAD MEDICARE
KYP00725741OtherRAILROAD MEDICARE
OH2949420Medicaid
OHP01702083OtherRAILROAD MEDICARE - MHCPI
OHH403842Medicare PIN
OHH403841Medicare PIN
OH4264313Medicare PIN
OH4264311Medicare PIN
KYP00725741OtherRAILROAD MEDICARE
OH4264312Medicare PIN
OH4264314Medicare PIN