Provider Demographics
NPI:1598891772
Name:LYONS, PATRICK F (OD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:F
Last Name:LYONS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-1837
Mailing Address - Country:US
Mailing Address - Phone:248-548-6888
Mailing Address - Fax:248-548-6889
Practice Address - Street 1:817 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1837
Practice Address - Country:US
Practice Address - Phone:248-548-6888
Practice Address - Fax:248-548-6889
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1780247Medicaid
MI0325050001Medicare ID - Type Unspecified
MIT33869Medicare UPIN