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Contact Information

STACIE R LYNN, OD
9863 BUSLETON AVE
STE A
PHILADELPHIA, PA19115
 Phone: 215-969-1100
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
 

Ophthalmology

207W00000X 18 Physician/Ophthalmology
Indicates primary specialty

NPI Profile & details for STACIE R LYNN · (Female)

NPI # 1639164247
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 09/20/2005
Last updated 03/19/2025 - More than a year ago
Sole proprietor 1 No
Identifiers
  • IL License # 046-009376
  • IL License # 046009376
  • PA License # OEG002050
  • IL Medicaid 046009376
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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