Provider Demographics
NPI:1568198364
Name:DR. MARK LYNN & ASSOCIATES PLLC
Entity Type:Organization
Organization Name:DR. MARK LYNN & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-500-4305
Mailing Address - Street 1:4802 ALBRECHT CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-5529
Mailing Address - Country:US
Mailing Address - Phone:502-500-4305
Mailing Address - Fax:
Practice Address - Street 1:801 EDITH RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2280
Practice Address - Country:US
Practice Address - Phone:502-308-5966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77010726Medicaid