Provider Demographics
NPI:1083066005
Name:LYNCH, RENEE THEROUX (OD)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:THEROUX
Last Name:LYNCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 BORTHWICK AVE STE 200E
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4184
Mailing Address - Country:US
Mailing Address - Phone:603-436-1773
Mailing Address - Fax:603-501-7867
Practice Address - Street 1:155 BORTHWICK AVE STE 200E
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4184
Practice Address - Country:US
Practice Address - Phone:603-436-1773
Practice Address - Fax:603-501-7867
Is Sole Proprietor?:No
Enumeration Date:2016-07-02
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003206152W00000X
NH0944152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075455Medicaid