Provider Demographics
NPI:1073694212
Name:STROMNESS, LYNN DAVID (OD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:DAVID
Last Name:STROMNESS
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 1:9565 S 700 E
Mailing Address - Street 2:STE 101
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3482
Mailing Address - Country:US
Mailing Address - Phone:801-876-1145
Mailing Address - Fax:801-576-8316
Practice Address - Street 1:9565 S 700 E
Practice Address - Street 2:STE 101
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3482
Practice Address - Country:US
Practice Address - Phone:801-876-1145
Practice Address - Fax:801-576-8316
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT113590-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005720701Medicare ID - Type Unspecified2
UTU10190Medicare UPIN