Provider Demographics
NPI:1548484447
Name:LIN, RON LUNG-JENG (OD)
Entity type:Individual
Prefix:DR
First Name:RON
Middle Name:LUNG-JENG
Last Name:LIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 STATE ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1164
Mailing Address - Country:US
Mailing Address - Phone:732-335-0004
Mailing Address - Fax:
Practice Address - Street 1:2145 STATE ROUTE 35
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1164
Practice Address - Country:US
Practice Address - Phone:732-335-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA 5775152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU96319Medicare UPIN