Provider Demographics
NPI:1427118876
Name:HUIZINGA, LYNN A (OD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:HUIZINGA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1909 EDSON DR
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-9471
Mailing Address - Country:US
Mailing Address - Phone:616-538-0610
Mailing Address - Fax:616-538-5781
Practice Address - Street 1:1700 S PARK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2779
Practice Address - Country:US
Practice Address - Phone:269-342-0003
Practice Address - Fax:269-342-4284
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002966152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI159664Medicare UPIN
MIN26930096Medicare PIN
MI07335000Medicare PIN
MI0C97655Medicare PIN