Provider Demographics
NPI:1467599837
Name:VERNA, LYN (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:LYN
Middle Name:
Last Name:VERNA
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26035 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-1848
Mailing Address - Country:US
Mailing Address - Phone:301-253-0734
Mailing Address - Fax:301-253-0736
Practice Address - Street 1:26035 RIDGE RD
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-1848
Practice Address - Country:US
Practice Address - Phone:301-253-0734
Practice Address - Fax:301-253-0736
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ-31TD00202600156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDNJ2026OtherEYEMED PROVIDER NUMBER
MD23106OtherNVA PROVIDER NUMBER