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General NPI Number Information
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NPI Number | 1134636491
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Entity Type | Organization
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Legal Business Name | LYNLEY E ATWOOD, LLC
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 01/08/2018
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Provider Practice Location Address
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Address Line | 422 W BETHALTO DR
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City | BETHALTO
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State | IL
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Zip | 62010
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Country | US
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Telephone | 618-377-5221
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Fax |
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Provider Business Mailing Address
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Address Line | 422 W BETHALTO DR
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City | BETHALTO
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State | IL
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Zip | 62010-1910
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Country | US
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Telephone | 618-377-5221
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. LYNLEY E ATWOOD
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Credential | OD
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Telephone | 618-377-5221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046.007313
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046.011008
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License Number State | IL
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