Provider Demographics
NPI:1346218591
Name:GABE, LYNN R (OD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:R
Last Name:GABE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 N WHITE MOUNTAIN RD
Mailing Address - Street 2:STE 18A
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-5273
Mailing Address - Country:US
Mailing Address - Phone:928-537-5565
Mailing Address - Fax:928-537-7597
Practice Address - Street 1:280 N WHITE MOUNTAIN RD
Practice Address - Street 2:STE 18A
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-5273
Practice Address - Country:US
Practice Address - Phone:928-537-5565
Practice Address - Fax:928-537-7597
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ68152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0170430OtherBCBS
T41630Medicare UPIN
AZZ860322799Medicare ID - Type Unspecified
AZAZ0170430OtherBCBS