Basic Information
| Provider Information | |||||||||
| NPI: | 1447904321 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WORSLEY | ||||||||
| FirstName: | LYNDER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19853 OUTER DR STE 110 | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481242044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134065056 | ||||||||
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| Practice Location | |||||||||
| Address1: | 27777 INKSTER RD | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483345310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484364400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2022 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156F00000X | N | Eye and Vision Services Providers | Technician/Technologist | 106S00000X | Y |
No ID Information.