Provider Demographics
NPI:1033794326
Name:LYNN FAMILY VISION AND TRAINING LLC
Entity Type:Organization
Organization Name:LYNN FAMILY VISION AND TRAINING LLC
Other - Org Name:LYNN FAMILY SPORTS VISION & TRAINING, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-645-2520
Mailing Address - Street 1:4802 ALBRECHT CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-5529
Mailing Address - Country:US
Mailing Address - Phone:502-645-2520
Mailing Address - Fax:
Practice Address - Street 1:801 EDITH RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2280
Practice Address - Country:US
Practice Address - Phone:502-645-2520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77010726Medicaid