Provider Demographics
NPI:1669201240
Name:MUNN, COURTNEY LYNN
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LYNN
Last Name:MUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14894 N STATE AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44062-9724
Mailing Address - Country:US
Mailing Address - Phone:440-632-1695
Mailing Address - Fax:440-368-0343
Practice Address - Street 1:14894 N STATE AVE
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:OH
Practice Address - Zip Code:44062-9724
Practice Address - Country:US
Practice Address - Phone:440-632-1695
Practice Address - Fax:440-368-0343
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.010297-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician