Provider Demographics
NPI:1396813473
Name:GASTON, LYNN M (OD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:M
Last Name:GASTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10395A N CHERRY DR
Mailing Address - Street 2:#3D
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2157
Mailing Address - Country:US
Mailing Address - Phone:816-734-0319
Mailing Address - Fax:816-232-5823
Practice Address - Street 1:4240 BLUE RIDGE BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-1754
Practice Address - Country:US
Practice Address - Phone:816-358-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004023125152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U81149Medicare UPIN