Healthcare Provider Details

I. General information

NPI: 1023040805
Provider Name (Legal Business Name): MARK LYNN OD & ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 01/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 ARBOR PLACE MALL
DOUGLASVILLE GA
30135-7108
US

IV. Provider business mailing address

PO BOX 848560
DALLAS TX
75284-8560
US

V. Phone/Fax

Practice location:
  • Phone: 770-852-1002
  • Fax: 770-947-9893
Mailing address:
  • Phone: 210-524-6663
  • Fax: 210-524-6587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MARK LYNN
Title or Position: OWNER
Credential: OD
Phone: 812-285-5050