Provider Demographics
NPI:1295893790
Name:DR LYN-MARIE BEHMKE OD
Entity type:Organization
Organization Name:DR LYN-MARIE BEHMKE OD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYN-MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHMKE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:401-434-5132
Mailing Address - Street 1:2728 PAWTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-3358
Mailing Address - Country:US
Mailing Address - Phone:401-434-5132
Mailing Address - Fax:401-435-5405
Practice Address - Street 1:2728 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-3358
Practice Address - Country:US
Practice Address - Phone:401-434-5132
Practice Address - Fax:401-435-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRIOD341152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI6012120001Medicare NSC