Provider Demographics
NPI:1184694861
Name:CARLI, LYNN MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:MARIE
Last Name:CARLI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 SOUTH MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4096
Mailing Address - Country:US
Mailing Address - Phone:920-435-9511
Mailing Address - Fax:920-435-9383
Practice Address - Street 1:535 SOUTH MONROE AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4096
Practice Address - Country:US
Practice Address - Phone:920-435-9511
Practice Address - Fax:920-435-9383
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1929152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI033704OtherAOA
WI0752560001OtherP-TAN
WI38524500Medicaid
WI38524500Medicaid
WI0752560001OtherP-TAN
WI38524500Medicaid