Healthcare Provider Details

I. General information

NPI: 1144252917
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: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 PLEASANT HILL RD STE 152
DULUTH GA
30096
US

IV. Provider business mailing address

PO BOX 848560
DALLAS TX
75284-8560
US

V. Phone/Fax

Practice location:
  • Phone: 678-475-0500
  • Fax: 678-475-0563
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