Provider Demographics
NPI:1053852699
Name:LYONS EYE OPTOMETRY, LLC
Entity Type:Organization
Organization Name:LYONS EYE OPTOMETRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-881-8899
Mailing Address - Street 1:PO BOX 1067
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:CO
Mailing Address - Zip Code:80540-1067
Mailing Address - Country:US
Mailing Address - Phone:303-747-3790
Mailing Address - Fax:
Practice Address - Street 1:138 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:CO
Practice Address - Zip Code:80540-0000
Practice Address - Country:US
Practice Address - Phone:303-747-3790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2875152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty