Provider Demographics
NPI:1336230572
Name:LYNCH, MAURICE A (OD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:A
Last Name:LYNCH
Suffix:
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 1:4900 TASSAJARA RD APT 1215
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4553
Mailing Address - Country:US
Mailing Address - Phone:214-642-6470
Mailing Address - Fax:214-750-1611
Practice Address - Street 1:4900 TASSAJARA RD APT 1215
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-4553
Practice Address - Country:US
Practice Address - Phone:214-642-6470
Practice Address - Fax:214-750-1611
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06489T152W00000X
CAOPT34731-TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82043QOtherBLUE CROSS BLUE SHIELD
TX82043QOtherBLUE CROSS BLUE SHIELD