Provider Demographics
NPI:1972531176
Name:LYNCH, WILLIAM ALBERT JR (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALBERT
Last Name:LYNCH
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101125OtherBLUE CROSS BLUE SHIELD
MO22-00550OtherUNITED HEALTH CARE
MO318275906Medicaid
MO10852950OtherCOUN. AFFORD. QUAL. HE CA
MOU06011Medicare UPIN
MO318275906Medicaid
MO0618480001Medicare NSC