Provider Demographics
NPI:1902288129
Name:LYNN, ASHLYN HOPE FERGUSON (OD)
Entity Type:Individual
Prefix:MRS
First Name:ASHLYN
Middle Name:HOPE FERGUSON
Last Name:LYNN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9002 N MERIDIAN STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260
Mailing Address - Country:US
Mailing Address - Phone:317-844-5530
Mailing Address - Fax:317-844-0882
Practice Address - Street 1:9002 N MERIDIAN STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-844-5530
Practice Address - Fax:317-844-0882
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003906A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201300170Medicaid
IN825700008Medicare PIN