Healthcare Provider Details

I. General information

NPI: 1942225032
Provider Name (Legal Business Name): LYNN ALLYSON MEYER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W 5TH AVE
GARY IN
46402-1807
US

IV. Provider business mailing address

3604 N GREENVIEW AVE APT 1
CHICAGO IL
60613-3608
US

V. Phone/Fax

Practice location:
  • Phone: 219-881-0655
  • Fax:
Mailing address:
  • Phone: 773-640-6266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003157
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: