MEDICARE: MARK LYNN, O.D. & ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1891122685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK LYNN, O.D. & ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 848560
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-8560
Country	:	US
Telephone Number	:	210-524-6803
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	6783 VETERANS PKWY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-3254
Country	:	US
Telephone Number	:	706-323-0260
Fax Number	:	706-323-0261

Authorized Official
Title or Position	:	OWNER
Name	:	MARK LYNN
Credential	:
Telephone Number	:	502-423-4444

Provider Enumeration Date	:	10/11/2013
Last Update Date	:	02/07/2014

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