MEDICARE: MARK LYNN OD & ASSOCIATES 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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1730111501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK LYNN OD & ASSOCIATES PC

Provider Business Mailing Address
First Line	:	PO BOX 848560
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-8560
Country	:	US
Telephone Number	:	210-524-6663
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	1245 CUMBERLAND MALL
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-3136
Country	:	US
Telephone Number	:	770-434-0440
Fax Number	:	770-434-5460

Authorized Official
Title or Position	:	OWNER
Name	:	MARK LYNN
Credential	:	OD
Telephone Number	:	812-285-5050

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	06/23/2009

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