Provider Demographics
NPI:1013164359
Name:LYNCH, JOHN J JR (RDO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:LYNCH
Suffix:JR
Gender:M
Credentials:RDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7665 POST RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-3220
Mailing Address - Country:US
Mailing Address - Phone:401-295-1334
Mailing Address - Fax:401-295-1358
Practice Address - Street 1:7665 POST RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-3220
Practice Address - Country:US
Practice Address - Phone:401-295-1334
Practice Address - Fax:401-295-1358
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI0114156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPV13450Medicaid