Provider Demographics
NPI:1134281942
Name:NEAL LOREY, LYNBETH (OD)
Entity Type:Individual
Prefix:DR
First Name:LYNBETH
Middle Name:
Last Name:NEAL LOREY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LYNBETH
Other - Middle Name:JEAN
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1025 CEDARMONT DR
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:TN
Mailing Address - Zip Code:37010-8025
Mailing Address - Country:US
Mailing Address - Phone:915-494-8671
Mailing Address - Fax:
Practice Address - Street 1:2315 MADISON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5454
Practice Address - Country:US
Practice Address - Phone:931-647-9411
Practice Address - Fax:931-647-9431
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1442DT152W00000X
TN2973152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN