Provider Demographics
NPI:1538222682
Name:STANFORD, LYNNE C (OD)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:C
Last Name:STANFORD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1464 HODLMAIR LN
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3123
Mailing Address - Country:US
Mailing Address - Phone:847-923-1340
Mailing Address - Fax:847-519-0626
Practice Address - Street 1:850 E GOLF RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4502
Practice Address - Country:US
Practice Address - Phone:847-519-1020
Practice Address - Fax:847-519-0626
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL154167Medicare UPIN