Healthcare Provider Details

I. General information

NPI: 1336565167
Provider Name (Legal Business Name): DR MARK LYNN & ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 E GREYHOUND PASS SUITE 2
CARMEL IN
46033-7787
US

IV. Provider business mailing address

PO BOX 846027
DALLAS TX
75284-6027
US

V. Phone/Fax

Practice location:
  • Phone: 317-569-0860
  • Fax: 317-569-0945
Mailing address:
  • Phone: 210-524-6803
  • 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: 502-423-4444