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General NPI Number Information
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NPI Number | 1598750416
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Entity Type | Individual
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Provider Name | LYNNETTE GAY DOARNBERGER O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 3230 BROADMOOR AVE SE STE A
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City | KENTWOOD
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State | MI
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Zip | 49512-8180
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Country | US
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Telephone | 616-534-4953
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Fax |
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Provider Business Mailing Address
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Address Line | 3230 BROADMOOR AVE SE STE A
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City | KENTWOOD
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State | MI
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Zip | 49512-8180
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Country | US
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Telephone | 616-534-4953
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901003563
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 4901003563
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 4901003563
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License Number State | MI
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