Provider Demographics
NPI:1356425508
Name:DR MARK LYNN & ASSOCIATES, PLLC
Entity type:Organization
Organization Name:DR MARK LYNN & ASSOCIATES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-285-5050
Mailing Address - Street 1:PO BOX 846027
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6027
Mailing Address - Country:US
Mailing Address - Phone:210-524-6663
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:3001 KNOXVILLE CENTER DR
Practice Address - Street 2:SUITE H03
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37924-5044
Practice Address - Country:US
Practice Address - Phone:865-524-2046
Practice Address - Fax:865-524-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1454176Medicaid
TN1240070019Medicare NSC