Provider Demographics
NPI:1558443853
Name:LYN A. SEDWICK, MD
Entity Type:Organization
Organization Name:LYN A. SEDWICK, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEURO-OPHTHAMALOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SEDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-896-8990
Mailing Address - Street 1:3030 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5531
Practice Address - Country:US
Practice Address - Phone:407-896-8990
Practice Address - Fax:407-896-6034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL37548174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79798Medicare ID - Type Unspecified
FLD58927Medicare UPIN