Provider Demographics
NPI:1114221538
Name:REBEKAH NOSS LYNCH O.D. LLC
Entity Type:Organization
Organization Name:REBEKAH NOSS LYNCH O.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:NOSS LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:231-943-4515
Mailing Address - Street 1:4627 CHOICE CIR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-7290
Mailing Address - Country:US
Mailing Address - Phone:231-943-4515
Mailing Address - Fax:
Practice Address - Street 1:8917 E 34 RD
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8851
Practice Address - Country:US
Practice Address - Phone:231-775-1141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004483152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty