Provider Demographics
NPI:1205835618
Name:BYERLY, LYNN KEPPLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:KEPPLE
Last Name:BYERLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 GOODLETTE RD N
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5609
Mailing Address - Country:US
Mailing Address - Phone:239-262-6288
Mailing Address - Fax:239-262-5434
Practice Address - Street 1:661 GOODLETTE RD N
Practice Address - Street 2:SUITE 105
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5609
Practice Address - Country:US
Practice Address - Phone:239-262-6288
Practice Address - Fax:239-262-5434
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036110938207W00000X
FLME100820207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9000192OtherBLUE CROSS BLUE SHIELD
IL036110938Medicaid
FL27332OtherBLUE CROSS BLUE SHIELD
ILD10456Medicare UPIN
ILK06903Medicare ID - Type Unspecified
IL9000192OtherBLUE CROSS BLUE SHIELD
FL27332OtherBLUE CROSS BLUE SHIELD
FLAK625ZMedicare PIN