Provider Demographics
NPI:1265476766
Name:LYONS, DENNIS H (OD FAAO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:H
Last Name:LYONS
Suffix:
Gender:M
Credentials:OD FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 CEDARBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-4159
Mailing Address - Country:US
Mailing Address - Phone:732-920-0110
Mailing Address - Fax:732-920-7881
Practice Address - Street 1:990 CEDARBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-4159
Practice Address - Country:US
Practice Address - Phone:732-920-0110
Practice Address - Fax:732-920-7881
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00341100152W00000X, 152WC0802X, 152WP0200X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2920603Medicaid
NJ0288720001Medicare NSC
NJLY467364Medicare PIN
NJ21159902Medicare UPIN