Healthcare Provider Details

I. General information

NPI: 1164472502
Provider Name (Legal Business Name): SHANNON C LYNCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7810 DAVENPORT ST
OMAHA NE
68114-3629
US

IV. Provider business mailing address

7810 DAVENPORT ST
OMAHA NE
68114-3629
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-1626
  • Fax: 402-397-1286
Mailing address:
  • Phone: 402-397-1626
  • Fax: 402-397-1286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35612
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: