Provider Demographics
NPI:1891963203
Name:PERKINS GLANCY, LYNN E (OPTICIAN NCLC)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:E
Last Name:PERKINS GLANCY
Suffix:
Gender:F
Credentials:OPTICIAN NCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E OSBORN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012
Mailing Address - Country:US
Mailing Address - Phone:602-277-3152
Mailing Address - Fax:602-234-1552
Practice Address - Street 1:300 E OSBORN
Practice Address - Street 2:
Practice Address - City:PHY
Practice Address - State:AZ
Practice Address - Zip Code:85012
Practice Address - Country:US
Practice Address - Phone:602-277-3152
Practice Address - Fax:602-234-1552
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ613156FC0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ25104OtherAVESIS