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General NPI Number Information
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NPI Number | 1619909470
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Entity Type | Organization
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Legal Business Name | MARK LYNN OD & ASSOCIATES PC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 4153 LA VISTA SUITE C
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City | TUCKER
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State | GA
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Zip | 30084-5344
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Country | US
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Telephone | 770-939-8828
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Fax | 770-939-3966
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Provider Business Mailing Address
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Address Line | PO BOX 848560
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City | DALLAS
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State | TX
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Zip | 75284-8560
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Country | US
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Telephone | 210-524-6663
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Fax | 210-524-6587
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Authorized Official
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Title or Position | OWNER
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Name | MARK LYNN
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Credential | OD
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Telephone | 812-285-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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