Provider Demographics
NPI:1073691010
Name:SELDON, LYNN M
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:SELDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S BEVERLY DR STE 307
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4806
Mailing Address - Country:US
Mailing Address - Phone:310-553-2224
Mailing Address - Fax:
Practice Address - Street 1:300 S BEVERLY DR STE 307
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4806
Practice Address - Country:US
Practice Address - Phone:310-553-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATPA7405152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP7405Medicare ID - Type Unspecified
CAT70195Medicare UPIN