Provider Demographics
NPI:1730111501
Name:MARK LYNN OD & ASSOCIATES PC
Entity Type:Organization
Organization Name:MARK LYNN OD & ASSOCIATES PC
Other - Org Name:DOCTOR'S VISIONWORKS
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 848560
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8560
Mailing Address - Country:US
Mailing Address - Phone:210-524-6663
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:1245 CUMBERLAND MALL
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3136
Practice Address - Country:US
Practice Address - Phone:770-434-0440
Practice Address - Fax:770-434-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5763790001Medicare NSC