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General NPI Number Information
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NPI Number | 1326099870
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Entity Type | Individual
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Provider Name | LYNN F GREENLEE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1145 OHIO AVE
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City | CANON CITY
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State | CO
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Zip | 81212-2278
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Country | US
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Telephone | 719-275-7481
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Fax | 719-275-0059
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Provider Business Mailing Address
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Address Line | 27 MONTEBELLO RD
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City | PUEBLO
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State | CO
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Zip | 81001-1236
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Country | US
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Telephone | 719-545-1530
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Fax | 719-545-2899
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 17215
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License Number State | CO
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