Provider Demographics
NPI:1326099870
Name:GREENLEE, LYNN F (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:F
Last Name:GREENLEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27 MONTEBELLO RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1236
Mailing Address - Country:US
Mailing Address - Phone:719-545-1530
Mailing Address - Fax:719-545-2899
Practice Address - Street 1:1145 OHIO AVE
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2278
Practice Address - Country:US
Practice Address - Phone:719-275-7481
Practice Address - Fax:719-275-0059
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17215207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01172154Medicaid
COCO7215OtherEYE MED EYECARE
COK2038OtherANTHEM
CO841207157OtherUNITED HEALTHCARE
CO182042704OtherRAILROAD MEDICARE
COK2038OtherFEDERAL BCBS
CO920726020820OtherEYE SPECIALISTS
CO608439600OtherUS DEP LABOR WORK COM
CO0452890001OtherMEDICARE DMERC
COD23221Medicare UPIN
COK2038Medicare ID - Type Unspecified