Stacie R Lynn, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG002050 Issued in PA

Practice address

9863 Busleton Ave
Ste a
Philadelphia, PA 19115

Phone

(215) 969-1100

NPI assigned

Sep 20, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Urban Eyecare, Inc.

  • Optometrist
  • Chicago, IL
  • NPI 1730342544
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742342400000",
    "number": "1639164247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 SLOAN WAY",
            "city": "AMBLER",
            "state": "PA",
            "postal_code": "190021205",
            "telephone_number": "773-531-5568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9863 BUSLETON AVE",
            "address_2": "STE A",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19115",
            "telephone_number": "215-969-1100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3241 S Michigan Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606163849",
            "country_code": "US",
            "telephone_number": "312-225-6200",
            "fax_number": "312-949-7660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LYNN",
        "first_name": "STACIE",
        "middle_name": "R",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-20",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "046009376",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG002050",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-009376",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046009376",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Anne Lynn, CRNP
• Jenny Colleen Lynn, CRNP
• Marissa Lynn, PA-C
• Nanette Lynn, CRNA
• Phillip David Lynn, DPM
• Karimah Shani Lynum, PHARM.D.
• Shawn Kag-Tso Lyo, MD
• Abigail Christine Lyon, PSY.D.
• Arthur James Lyon, MD
• Gyrid Lyon, PH.D.

• Optometrist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.