Provider Demographics
NPI:1831470350
Name:LYERLY, JENNIFER (OD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LYERLY
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 1:1004 LOWER SHILOH WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5431
Mailing Address - Country:US
Mailing Address - Phone:919-472-4070
Mailing Address - Fax:919-472-4070
Practice Address - Street 1:1004 LOWER SHILOH WAY STE 105
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-5431
Practice Address - Country:US
Practice Address - Phone:919-472-4070
Practice Address - Fax:919-472-4070
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2241152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5918970Medicaid
NCNC3544IMedicare PIN
NCNC3544LMedicare PIN
NC3544BMedicare PIN
NC5918970Medicaid
NC3544CMedicare PIN
NC3544DMedicare PIN
NC3544EMedicare PIN
NCNC3544AMedicare PIN
NC3544FMedicare PIN
NCNC3544GMedicare PIN
NCNC3544HMedicare PIN
NCNC3544JMedicare PIN
NC167F8OtherNCBCBS