Provider Demographics
NPI:1538175831
Name:LYNCH, DENNIS (OD)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:LYNCH
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 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-249-8300
Mailing Address - Fax:585-249-5361
Practice Address - Street 1:500 KREAG RD
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3705
Practice Address - Country:US
Practice Address - Phone:585-249-8300
Practice Address - Fax:585-249-8361
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004632152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU44693Medicare UPIN
NY410027107Medicare ID - Type Unspecified