MEDICARE: LYNN M DIMARTINO OD PC

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	305S00000X	Point of Service	4901002999	MI

General Provider Information

NPI Number	:	1265609101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYNN M DIMARTINO OD PC

Provider Business Mailing Address
First Line	:	7055 TOWER RD
Second Line	:	SUITE E
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-8604
Country	:	US
Telephone Number	:	269-968-8183
Fax Number	:	269-968-1998

Provider Business Practice Location Address
First Line	:	7055 TOWER RD
Second Line	:	SUITE E
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-8604
Country	:	US
Telephone Number	:	269-968-8183
Fax Number	:	269-968-1998

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LYNN M DIMARTINO
Credential	:	O.D.
Telephone Number	:	269-968-8183

Provider Enumeration Date	:	05/09/2008
Last Update Date	:	12/17/2009

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