Provider Demographics
NPI:1144295809
Name:COON, LYNN J (OD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:J
Last Name:COON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 E WESTPOINT DR
Mailing Address - Street 2:STE 207
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-373-0225
Mailing Address - Fax:907-373-7776
Practice Address - Street 1:935 E WESTPOINT DR
Practice Address - Street 2:STE 207
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-373-0225
Practice Address - Fax:907-373-7776
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK90152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOD00902Medicaid
AKK153415Medicare ID - Type Unspecified
AKOD00902Medicaid