Provider Demographics
NPI:1144225194
Name:BURR, LYNDA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:MARIE
Last Name:BURR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LYNDA
Other - Middle Name:MARIE
Other - Last Name:BURR-BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4444 1ST AVE NE
Mailing Address - Street 2:STE 575
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3243
Mailing Address - Country:US
Mailing Address - Phone:319-395-7692
Mailing Address - Fax:
Practice Address - Street 1:4444 1ST AVE NE
Practice Address - Street 2:STE 575
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3243
Practice Address - Country:US
Practice Address - Phone:319-395-7692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2017-01-09
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
IA02197152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA35489OtherBLUE CROSS BLUE SHIELD
IA4264689Medicaid
IAU90707Medicare UPIN
I6699Medicare PIN