Jerry T Lin, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

11077T Issued in CA

Practice address

630 N Rose Dr
Placentia, CA 92870-7513

Phone

(714) 524-6688

Fax

(714) 524-7678

NPI assigned

Feb 20, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• C & C Optometry, Inc.

  • Optometrist
  • Orange, CA
  • NPI 1730558784
  NPD (past)
• Matty Chang OD Inc

  • Optometrist
  • Placentia, CA
  • NPI 1487887576
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710022686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 N ROSE DR",
            "city": "PLACENTIA",
            "state": "CA",
            "postal_code": "928707513",
            "telephone_number": "714-524-6688",
            "fax_number": "714-524-7678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 N ROSE DR",
            "city": "PLACENTIA",
            "state": "CA",
            "postal_code": "928707513",
            "telephone_number": "714-524-6688",
            "fax_number": "714-524-7678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIN",
        "first_name": "JERRY",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "11077T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0110770",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angelina Marie Ligorria
• Lisa Liltz, CCC-SLP
• Suhyun Lim
• Lin Physical Therapy, LLC
• Donny I-Fon Lin, PT
• Megan Linhares
• Robert Lobato
• Fanay Loiselle, LMFT
• Rosita Lok, SLPA
• Long Beach Vamc

• Optometrist in Placentia, CA
• Providers in Placentia, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.