Provider Demographics
NPI:1588043137
Name:LYON, ELIZABETH (OD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LYON
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 1:2221 E BIJOU ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-8009
Mailing Address - Country:US
Mailing Address - Phone:719-576-1850
Mailing Address - Fax:719-955-3470
Practice Address - Street 1:3630 AUSTIN BLUFFS PKWY STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6663
Practice Address - Country:US
Practice Address - Phone:719-304-5400
Practice Address - Fax:719-304-5409
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00655000152WV0400X
COOPT.0003123152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
COOPT.0003123OtherCO OPTOMETRY LICENSE
CO72671815Medicaid