Active NPI
Mimi Lum
- Optometrist
- Bethesda, MD
National Provider Identifier
1407076292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- TA1990
- Practice address
- 4975 North Palmer Rd 85T
Bethesda, MD 20889-3506 - Phone
- (301) 319-7087
- NPI assigned
- Apr 26, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | TA1990 | MD | Primary |
Addresses
Primary practice location
4975 North Palmer Rd 85T
Bethesda, MD 20889-3506
Mailing address
13 Eton Overlook
Rockville, MD 20850-3003
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110502000298 | MD | Order and Referring Only - Optometry | 3375728652 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TA1990 | MD | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720483200000",
"number": "1407076292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13 ETON OVERLOOK",
"city": "ROCKVILLE",
"state": "MD",
"postal_code": "208503003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4975 NORTH PALMER RD 85T",
"city": "BETHESDA",
"state": "MD",
"postal_code": "208893506",
"telephone_number": "301-319-7087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUM",
"first_name": "MIMI",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-26",
"last_updated": "2024-07-09",
"certification_date": "2024-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MD",
"license": "TA1990",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bethesda, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.