=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295714103
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPTOMETRY ASSOCIATES, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2006
-----------------------------------------------------
Last Update Date | 07/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 419 N MARKET ST
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19801-3002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-654-6490
-----------------------------------------------------
Fax | 302-654-9527
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 419 N MARKET ST
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19801-3002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-654-6490
-----------------------------------------------------
Fax | 302-654-9527
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ OPTOMETRIST
-----------------------------------------------------
Name | DR. PATRICIA ANN LYNCH
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 302-654-6490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 1989020052
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------