Provider Demographics
NPI:1174608640
Name:LYNLY, BRENDA K (OD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:K
Last Name:LYNLY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:L
Other - Last Name:KAMSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:410 MT ARLINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:07850-1315
Mailing Address - Country:US
Mailing Address - Phone:973-770-4706
Mailing Address - Fax:
Practice Address - Street 1:369 SPRINGFIELD AVENUE
Practice Address - Street 2:SUBURBAN EYE INSTITUTE
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1170
Practice Address - Country:US
Practice Address - Phone:908-464-0123
Practice Address - Fax:908-665-2936
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00545500152W00000X
NJ27OM00043100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U64405Medicare UPIN