Provider Demographics
NPI:1275960445
Name:DR. MARK LYNN & ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:DR. MARK LYNN & ASSOCIATES, PLLC
Other - Org Name:VISIONWORKS DOCTORS OF OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-423-4444
Mailing Address - Street 1:PO BOX 846027
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6027
Mailing Address - Country:US
Mailing Address - Phone:210-340-3531
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:338 GOODMAN RD W
Practice Address - Street 2:
Practice Address - City:SOUTHHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9522
Practice Address - Country:US
Practice Address - Phone:662-349-1139
Practice Address - Fax:662-349-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier