Basic Information
| Provider Information | |||||||||
| NPI: | 1780874552 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LYNNE UNGER, ODPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1879 E SHERMAN BLVD | ||||||||
| Address2: | WALMART VISION CENTER | ||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494441858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317397124 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1879 E SHERMAN BLVD | ||||||||
| Address2: | WALMART VISION CENTER | ||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494441858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317397124 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2007 | ||||||||
| LastUpdateDate: | 07/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | UNGER | ||||||||
| AuthorizedOfficialFirstName: | LYNNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6164052588 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
No ID Information.