Provider Demographics
NPI:1164472502
Name:LYNCH, SHANNON C (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:C
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7810 DAVENPORT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3629
Mailing Address - Country:US
Mailing Address - Phone:402-397-1626
Mailing Address - Fax:402-397-1286
Practice Address - Street 1:7810 DAVENPORT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3629
Practice Address - Country:US
Practice Address - Phone:402-397-1626
Practice Address - Fax:402-397-1286
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE35612207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1440172OtherIA MEDICAID
NEP00255927OtherRR MEDICARE
NE10025269300Medicaid
NEP00255927OtherRR MEDICARE
NEI07562Medicare UPIN