Provider Demographics
NPI:1538385968
Name:LIN, SUSAN (OD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:131 MARKHAM PL
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1400
Mailing Address - Country:US
Mailing Address - Phone:732-851-4996
Mailing Address - Fax:
Practice Address - Street 1:131 MARKHAM PL
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1400
Practice Address - Country:US
Practice Address - Phone:732-530-8610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA 5774152W00000X
NJOA5774332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU96378Medicare UPIN
NJ208762Medicare PIN