Healthcare Provider Details

I. General information

NPI: 1033794326
Provider Name (Legal Business Name): LYNN FAMILY VISION AND TRAINING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 EDITH RD
LOUISVILLE KY
40206-2280
US

IV. Provider business mailing address

4802 ALBRECHT CT
LOUISVILLE KY
40241-5529
US

V. Phone/Fax

Practice location:
  • Phone: 502-645-2520
  • Fax:
Mailing address:
  • Phone: 502-645-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK E LYNN
Title or Position: OWNER
Credential: OD
Phone: 502-645-2520