Provider Demographics
NPI:1801859400
Name:LYN, MAURICE JOSE (OD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:JOSE
Last Name:LYN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:638 CLANTON MARKETPLACE
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-2246
Mailing Address - Country:US
Mailing Address - Phone:205-755-3636
Mailing Address - Fax:205-755-3777
Practice Address - Street 1:638 CLANTON MARKETPLACE
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2246
Practice Address - Country:US
Practice Address - Phone:205-755-3636
Practice Address - Fax:205-755-3777
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR119TA114152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6046610001Medicare NSC
U35340Medicare UPIN