Provider Demographics
NPI:1942225032
Name:MEYER, LYNN ALLYSON (OD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:ALLYSON
Last Name:MEYER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 N GREENVIEW AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3608
Mailing Address - Country:US
Mailing Address - Phone:773-640-6266
Mailing Address - Fax:
Practice Address - Street 1:701 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-1807
Practice Address - Country:US
Practice Address - Phone:219-881-0655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003157152W00000X
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U86399Medicare UPIN