Provider Demographics
NPI:1750313524
Name:MARK LYNN, O.D. & ASSOCIATES P.C.
Entity Type:Organization
Organization Name:MARK LYNN, O.D. & ASSOCIATES P.C.
Other - Org Name: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 1:400 BARRETT PKWY
Practice Address - Street 2:SUITE 158
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4917
Practice Address - Country:US
Practice Address - Phone:770-429-1660
Practice Address - Fax:770-429-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5763790003Medicare NSC