Lynn Pavlic, OD LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

0E007059T Issued in PA

Legal business name

LYNN PAVLIC, OD LLC

Practice address

150 W Beau St
Suite 112
Washington, PA 15301-4425

Phone

(724) 225-4440

Fax

(724) 225-5125

NPI assigned

Dec 17, 2010

Last updated

Mar 11, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lynn PavlicNPI 1669490157

Title

Owner

Phone

(724) 225-4440

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lynn Pavlic, OD

  • Optometrist
  • Washington, PA
  • NPI 1669490157
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1292544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299801600000",
    "number": "1861795510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 W BEAU ST",
            "address_2": "SUITE 112",
            "city": "WASHINGTON",
            "state": "PA",
            "postal_code": "153014425",
            "telephone_number": "724-225-4440",
            "fax_number": "724-225-5125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 W BEAU ST",
            "address_2": "SUITE 112",
            "city": "WASHINGTON",
            "state": "PA",
            "postal_code": "153014425",
            "telephone_number": "724-225-4440",
            "fax_number": "724-225-5125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYNN PAVLIC, OD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-17",
        "last_updated": "2011-03-11",
        "status": "A",
        "authorized_official_last_name": "PAVLIC",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "724-225-4440"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "0E007059T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012949600001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.