Provider Demographics
NPI:1508940875
Name:DR MARK LYNN & ASSOCIATES P L L C
Entity Type:Organization
Organization Name:DR MARK LYNN & ASSOCIATES P L L C
Other - Org Name:VISIONWORKS DOCTORS OF OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-285-5050
Mailing Address - Street 1:PO BOX 846027
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6027
Mailing Address - Country:US
Mailing Address - Phone:210-524-6663
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:7600 KINGSTON PIKE
Practice Address - Street 2:SUITE 1110A
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5600
Practice Address - Country:US
Practice Address - Phone:865-531-3295
Practice Address - Fax:865-531-8937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454179Medicaid
TN1454179Medicaid