Healthcare Provider Details

I. General information

NPI: 1396007951
Provider Name (Legal Business Name): PAMELA DAWN LYNCH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA DAWN RECKOW OD

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 1ST ST
MANISTEE MI
49660-1702
US

IV. Provider business mailing address

328 1ST ST
MANISTEE MI
49660-1702
US

V. Phone/Fax

Practice location:
  • Phone: 231-723-9911
  • Fax: 231-723-9914
Mailing address:
  • Phone: 231-723-9911
  • Fax: 231-723-9914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004698
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: