Provider Demographics
NPI:1407809973
Name:LYN, BETHANY BAKER (OD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:BAKER
Last Name:LYN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15933 CLAYTON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2172
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:1100 LAY DAM RD
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2308
Practice Address - Country:US
Practice Address - Phone:205-755-1351
Practice Address - Fax:205-755-0351
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALR118TA113152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0950310001Medicare NSC