Provider Demographics
NPI:1710060405
Name:LYONS, AUDREY EDWARDS (OD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:EDWARDS
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 1:790 MONTCLAIR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1966
Mailing Address - Country:US
Mailing Address - Phone:205-592-3911
Mailing Address - Fax:205-592-3537
Practice Address - Street 1:1480 TIMBERLANE RD STE 100
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-1713
Practice Address - Country:US
Practice Address - Phone:205-592-3911
Practice Address - Fax:205-592-3537
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSA84TA659152W00000X
FLOPC5003152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51529350OtherBCBS