MEDICARE: DR. LYNN R HENRY 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	TUV003458-1	NY

General Provider Information

NPI Number	:	1447257480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNN R HENRY O.D.

Provider Business Mailing Address
First Line	:	23 CENTRAL PLZ
Second Line	:
City	:	ILION
State	:	NY
Zip	:	13357-1701
Country	:	US
Telephone Number	:	315-894-3325
Fax Number	:	315-894-6000

Provider Business Practice Location Address
First Line	:	23 CENTRAL PLZ
Second Line	:
City	:	ILION
State	:	NY
Zip	:	13357-1701
Country	:	US
Telephone Number	:	315-894-3325
Fax Number	:	315-894-6000

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

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	05/14/2008

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