Provider Demographics
NPI:1134168719
Name:O'NEAL, LYNN WESLEY (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:WESLEY
Last Name:O'NEAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:W
Other - Last Name:ONEAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2411 PRINCETON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-1625
Mailing Address - Country:US
Mailing Address - Phone:785-840-9718
Mailing Address - Fax:
Practice Address - Street 1:2411 PRINCETON BLVD STE 214
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-1625
Practice Address - Country:US
Practice Address - Phone:785-424-0901
Practice Address - Fax:785-841-2765
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-21364207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSD05318Medicare UPIN
016353Medicare ID - Type Unspecified