Provider Demographics
NPI:1205992260
Name:LYNASS, WILLIAM J (MD OD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:LYNASS
Suffix:
Gender:M
Credentials:MD OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-9095
Mailing Address - Country:US
Mailing Address - Phone:970-522-9287
Mailing Address - Fax:970-522-5953
Practice Address - Street 1:1510 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-9095
Practice Address - Country:US
Practice Address - Phone:970-522-9287
Practice Address - Fax:970-522-5953
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2655ATI152W00000X
CO2717152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U69466Medicare UPIN
101167Medicare ID - Type Unspecified