Organization Name: | LYNN J WYATT |
NPI Number: | 1538384490 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LYNN J WYATT (OPTICIAN OWNER) |
Mailing Address: | 18 Nickman Plaza Lemont Furnace |
State: | PA US |
Postal Code: | 15456 |
Phone Number: | 7244385120 |
Fax Number: | 7244385142 |
NPI Enumeration Date: | 04/16/2007 |
NPI Last Update Date: | 07/30/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |