Provider Demographics
NPI:1710509179
Name:PICKRELL, LYDIA MARY (OD, MS)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:MARY
Last Name:PICKRELL
Suffix:
Gender:F
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 KREAG RD
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3705
Mailing Address - Country:US
Mailing Address - Phone:585-249-8300
Mailing Address - Fax:
Practice Address - Street 1:500 KREAG RD
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3705
Practice Address - Country:US
Practice Address - Phone:585-249-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009124152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist