MEDICARE: LYNN DAVID STROMNESS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	113590-9934	UT

General Provider Information

NPI Number	:	1073694212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN DAVID STROMNESS O.D.

Provider Business Mailing Address
First Line	:	9565 S 700 E
Second Line	:	STE 101
City	:	SANDY
State	:	UT
Zip	:	84070-3482
Country	:	US
Telephone Number	:	801-876-1145
Fax Number	:	801-576-8316

Provider Business Practice Location Address
First Line	:	9565 S 700 E
Second Line	:	STE 101
City	:	SANDY
State	:	UT
Zip	:	84070-3482
Country	:	US
Telephone Number	:	801-876-1145
Fax Number	:	801-576-8316

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	10/16/2009

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