Provider Demographics
NPI:1245211713
Name:PORRECA, LYNNE M (OD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:M
Last Name:PORRECA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BUCK ST
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-3817
Mailing Address - Country:US
Mailing Address - Phone:856-825-1011
Mailing Address - Fax:856-327-1333
Practice Address - Street 1:211 BUCK ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-3817
Practice Address - Country:US
Practice Address - Phone:856-825-1011
Practice Address - Fax:856-327-1333
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ 4381152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4501878OtherAETNA
NJ521539Medicare PIN
U19948Medicare UPIN