Provider Demographics
NPI:1275608036
Name:SCULLION, LYNN BLAIR (OD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:BLAIR
Last Name:SCULLION
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 1:201 W LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-1103
Mailing Address - Country:US
Mailing Address - Phone:330-424-7044
Mailing Address - Fax:
Practice Address - Street 1:201 W LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-1103
Practice Address - Country:US
Practice Address - Phone:330-424-7044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4006152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0102614Medicaid
OHT90530Medicare UPIN
OH0387490001Medicare NSC
OH0102614Medicaid
OHSC0658291Medicare Oscar/Certification