Provider Demographics
NPI:1255472841
Name:LYNN EYE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:LYNN EYE SURGERY CENTER, LLC
Other - Org Name:LYNN EYE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CORWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-370-3137
Mailing Address - Street 1:75 ENTERPRISE
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2629
Mailing Address - Country:US
Mailing Address - Phone:949-688-6205
Mailing Address - Fax:
Practice Address - Street 1:2230 LYNN RD STE 106
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1972
Practice Address - Country:US
Practice Address - Phone:805-370-3137
Practice Address - Fax:805-370-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS551003Medicare ID - Type Unspecified