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NPI Code Detail

MEDICARE: DR. LYNN MARIE DIMARTINO O.D.

MEDICARE: DR. LYNN MARIE DIMARTINO 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
1152W00000XOptometrist4901002999MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10A31152OTHERMIBLUE CROSS BLUE SHIELD #
20326890001OTHERMIADMINISTAR PIN#

General Provider Information

NPI Number : 1609956978
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LYNN MARIE DIMARTINO O.D.
Provider Business Mailing Address
First Line : 8614 WESTWOOD CENTER DR FL 9
Second Line :
City : VIENNA
State : VA
Zip : 22182-2442
Country : US
Telephone Number : 703-847-8899
Fax Number :
Provider Business Practice Location Address
First Line : 100 NORTH AVE
Second Line :
City : BATTLE CREEK
State : MI
Zip : 49017-3417
Country : US
Telephone Number : 269-962-7595
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 05/31/2024

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