Provider Demographics
NPI:1396007951
Name:LYNCH, PAMELA DAWN (OD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DAWN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:DAWN
Other - Last Name:RECKOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2200 JEFFERSON AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1180 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3190
Practice Address - Country:US
Practice Address - Phone:734-243-5300
Practice Address - Fax:734-243-3236
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004698152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist