Provider Demographics
NPI:1578823829
Name:LYN DESJARDINS OPTOMETRY LLC
Entity Type:Organization
Organization Name:LYN DESJARDINS OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DESJARDINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-283-0650
Mailing Address - Street 1:127 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1802
Mailing Address - Country:US
Mailing Address - Phone:978-283-0650
Mailing Address - Fax:978-281-5584
Practice Address - Street 1:127 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-1802
Practice Address - Country:US
Practice Address - Phone:978-283-0650
Practice Address - Fax:978-281-5584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4853152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty