Provider Demographics
NPI:1992875868
Name:BURFORD, LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:
Last Name:BURFORD
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 1:10485 N. PENNSYLVANIA
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280
Mailing Address - Country:US
Mailing Address - Phone:317-846-7600
Mailing Address - Fax:
Practice Address - Street 1:10485 N. PENNSYLVANIA
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280
Practice Address - Country:US
Practice Address - Phone:317-846-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002434A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT98131Medicare UPIN
IN247530Medicare ID - Type Unspecified
IN4118960001Medicare NSC