Provider Demographics
NPI:1225241714
Name:LYONS, KIMBERLY MACHELE (OD)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MACHELE
Last Name:LYONS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 LAKEWOOD DR
Mailing Address - Street 2:STE. 11
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-7856
Mailing Address - Country:US
Mailing Address - Phone:707-838-9393
Mailing Address - Fax:707-838-6688
Practice Address - Street 1:8911 LAKEWOOD DR
Practice Address - Street 2:STE. 11
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-7856
Practice Address - Country:US
Practice Address - Phone:707-838-9393
Practice Address - Fax:707-838-6688
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12837T152W00000X
CA12837152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV05814Medicare UPIN
CAFJ632AMedicare PIN