Provider Demographics
NPI:1003827015
Name:DAYNES, LINCOLN JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:LINCOLN
Middle Name:JOSEPH
Last Name:DAYNES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W FRY BLVD
Mailing Address - Street 2:STE. 9
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-1758
Mailing Address - Country:US
Mailing Address - Phone:520-459-1650
Mailing Address - Fax:520-459-6202
Practice Address - Street 1:400 W FRY BLVD
Practice Address - Street 2:STE. 9
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-1758
Practice Address - Country:US
Practice Address - Phone:520-459-1650
Practice Address - Fax:520-459-6202
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ592152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z155900Medicare PIN
AZ1006840001Medicare NSC
AZT67107Medicare UPIN