Provider Demographics
NPI:1801871801
Name:LINK, LAUREEN KAYE (OD)
Entity type:Individual
Prefix:DR
First Name:LAUREEN
Middle Name:KAYE
Last Name:LINK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3241 CHURN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2516
Mailing Address - Country:US
Mailing Address - Phone:530-222-2020
Mailing Address - Fax:530-222-2078
Practice Address - Street 1:3241 CHURN CREEK RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2516
Practice Address - Country:US
Practice Address - Phone:530-222-2020
Practice Address - Fax:530-222-2078
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07261T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0072610Medicaid
CAT10503Medicare UPIN
CAAZ582Medicare PIN
CA0200350001Medicare NSC