Provider Demographics
NPI:1093892812
Name:LYNCH, JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:LYNCH
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 BRIDGEVILLE HWY
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-1616
Practice Address - Country:US
Practice Address - Phone:302-262-8498
Practice Address - Fax:302-629-3335
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE13-0001314152W00000X
MDTA0753152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD307590700Medicaid
P00969173OtherRR MEDICARE PIN
DE0000217222Medicaid
MDT55918Medicare UPIN
410026566Medicare PIN
352L822BMedicare PIN
353L826BMedicare PIN
350L814BMedicare PIN
334L746BMedicare PIN
MD307590700Medicaid