Provider Demographics
NPI:1396834115
Name:MARTIN, LYNNE K (OD)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:K
Last Name:MARTIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:EVA
Other - Middle Name:LYNNE
Other - Last Name:KENNINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1308 ARRONIMINK CIR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6303
Mailing Address - Country:US
Mailing Address - Phone:512-785-0624
Mailing Address - Fax:
Practice Address - Street 1:2701 S INTERSTATE 35
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7320
Practice Address - Country:US
Practice Address - Phone:512-388-2600
Practice Address - Fax:512-388-2600
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4499T152W00000X, 152WC0802X, 152W00000X
GAOPT000951152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX47839OtherDAVIS
TX920532OtherBLOCK (CHIP & AMERIGROUP)
TX019327801Medicaid
TX26903OtherSPECTERA
TX35403OtherAVESIS
TX64765OtherSAFEGUARD
TX26310OtherMEDICAL EYE SERVICES
TX47839OtherDAVIS VISION