Healthcare Provider Details

I. General information

NPI: 1275960445
Provider Name (Legal Business Name): DR. MARK LYNN & ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 GOODMAN RD W
SOUTHHAVEN MS
38671-9522
US

IV. Provider business mailing address

PO BOX 846027
DALLAS TX
75284-6027
US

V. Phone/Fax

Practice location:
  • Phone: 662-349-1139
  • Fax: 662-349-1140
Mailing address:
  • Phone: 210-340-3531
  • 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:
Phone: 502-423-4444