Provider Demographics
NPI:1861559072
Name:WITTMAN, LYNN (OD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:WITTMAN
Suffix:
Gender:F
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:ONE WASHINGTON STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481
Mailing Address - Country:US
Mailing Address - Phone:617-332-1471
Mailing Address - Fax:617-332-2735
Practice Address - Street 1:ONE WASHINGTON STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481
Practice Address - Country:US
Practice Address - Phone:617-332-1471
Practice Address - Fax:617-332-2735
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2589152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2200480OtherUNITED
0035556OtherNHP
W16105OtherBCBS
15648OtherHPHC
MA0316296Medicaid
755278OtherTUFTS
B21146901OtherCIGNA
15648OtherHPHC
T59445Medicare UPIN