Provider Demographics
NPI:1043768039
Name:MARK LYNN OD & ASSOCIATES, PC
Entity Type:Organization
Organization Name:MARK LYNN OD & ASSOCIATES, PC
Other - Org Name:VISIONWORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-423-4444
Mailing Address - Street 1:PO BOX 848560
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8560
Mailing Address - Country:US
Mailing Address - Phone:800-349-5120
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:7300 N POINT PKWY
Practice Address - Street 2:STE 122
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-4818
Practice Address - Country:US
Practice Address - Phone:770-752-0763
Practice Address - Fax:770-752-0764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier