Provider Demographics
NPI:1851870190
Name:MALLORY LYNCH, OD, PLLC
Entity Type:Organization
Organization Name:MALLORY LYNCH, OD, PLLC
Other - Org Name:TECH RIDGE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MALLORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-837-3200
Mailing Address - Street 1:500 CANYON RIDGE DR. SUITE L300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753
Mailing Address - Country:US
Mailing Address - Phone:512-837-3200
Mailing Address - Fax:
Practice Address - Street 1:500 CANYON RIDGE DR. SUITE L300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753
Practice Address - Country:US
Practice Address - Phone:512-837-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty