Provider Demographics
NPI:1881630366
Name:LYNCH DEVELOPMENT, P.C.
Entity Type:Organization
Organization Name:LYNCH DEVELOPMENT, P.C.
Other - Org Name:CRAWFORD COUNTY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:573-885-2323
Mailing Address - Street 1:402 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:MO
Mailing Address - Zip Code:65453-1217
Mailing Address - Country:US
Mailing Address - Phone:573-885-2323
Mailing Address - Fax:573-885-2643
Practice Address - Street 1:402 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:MO
Practice Address - Zip Code:65453-1217
Practice Address - Country:US
Practice Address - Phone:573-885-2323
Practice Address - Fax:573-885-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10852950OtherCAQHEALTH CARE
MO22-00550OtherUNITED HEALTH CARE
MO101125OtherBLUE CROSS BLUE SHIELD
MO318275906Medicaid
MO318275906Medicaid
MO0618480001Medicare NSC
MO101125OtherBLUE CROSS BLUE SHIELD