Provider Demographics
NPI:1255022398
Name:PERRY, LYNDA MICHELLE (ABOC)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:MICHELLE
Last Name:PERRY
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 ANDERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76120-3857
Mailing Address - Country:US
Mailing Address - Phone:817-276-9072
Mailing Address - Fax:817-276-9076
Practice Address - Street 1:8401 ANDERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76120-3857
Practice Address - Country:US
Practice Address - Phone:817-276-9072
Practice Address - Fax:817-276-9076
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX161667156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician