Active NPI
Polen Lim, O.D.
- Optometrist
- Long Beach, CA
National Provider Identifier
1407868920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 12694T
- Practice address
- 709 E Anaheim St
Long Beach, CA 90813-3507 - Phone
- (562) 591-7700
- NPI assigned
- Aug 13, 2006
- Sex
- Female
- Sole proprietor
- No
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 | 12694T | CA | Primary |
Addresses
Primary practice location
709 E Anaheim St
Long Beach, CA 90813-3507
Mailing address
1326 E 9TH St
Long Beach, CA 90813-4925
Phone (562) 591-7700
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12694T | Other | CA | LICENSE NUMBER |
| SD0126940 | Other | CA | MEDI-CAL PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12694T | CA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1407868920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1326 E 9TH ST",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908134925",
"telephone_number": "562-591-7700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "709 E ANAHEIM ST",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908133507",
"telephone_number": "562-591-7700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIM",
"first_name": "POLEN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-13",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "12694T",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "12694T",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI-CAL PROVIDER NUMBER",
"identifier": "SD0126940",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.