Provider Demographics
NPI:1386066751
Name:MARK LYNN O.D. & ASSOCIATES, PC
Entity type:Organization
Organization Name:MARK LYNN O.D. & ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-423-4444
Mailing Address - Street 1:PO BOX 848560
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8560
Mailing Address - Country:US
Mailing Address - Phone:210-524-6771
Mailing Address - Fax:
Practice Address - Street 1:2745 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-2949
Practice Address - Country:US
Practice Address - Phone:478-953-1993
Practice Address - Fax:478-953-4695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-20
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5763790021Medicare NSC