Healthcare Provider Details

I. General information

NPI: 1679579189
Provider Name (Legal Business Name): LYNN ANNE FINNEGAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHPORT VAMC-OPTOMETRY SERVICE 79 MIDDLEVILE RD
NORTHPORT NY
11768-2200
US

IV. Provider business mailing address

2 VACATION CT
HOLBROOK NY
11741-1614
US

V. Phone/Fax

Practice location:
  • Phone: 631-261-4400
  • Fax:
Mailing address:
  • Phone: 631-471-9710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT0005107
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: